Provider Demographics
NPI:1114092699
Name:GORDON, THOMAS ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ANTHONY
Last Name:GORDON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8605 CAMINO MEDIA
Mailing Address - Street 2:SUITE. 100
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-1355
Mailing Address - Country:US
Mailing Address - Phone:661-664-1814
Mailing Address - Fax:661-664-0129
Practice Address - Street 1:8605 CAMINO MEDIA
Practice Address - Street 2:SUITE. 100
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-1355
Practice Address - Country:US
Practice Address - Phone:661-664-1814
Practice Address - Fax:661-664-0129
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice