Provider Demographics
NPI:1114175528
Name:GORDON, LATONYA COWSER (DDS)
Entity Type:Individual
Prefix:DR
First Name:LATONYA
Middle Name:COWSER
Last Name:GORDON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 MOUNT ZION PL
Mailing Address - Street 2:SUITE B
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-3254
Mailing Address - Country:US
Mailing Address - Phone:336-748-0033
Mailing Address - Fax:336-748-0414
Practice Address - Street 1:1500 MOUNT ZION PL
Practice Address - Street 2:SUITE B
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-3254
Practice Address - Country:US
Practice Address - Phone:336-748-0033
Practice Address - Fax:336-748-0414
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7609122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist