Provider Demographics
NPI:1134311210
Name:GORDON, MEGAN HELGA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:HELGA
Last Name:GORDON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARILYN
Other - Middle Name:HELGA
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:742 FM 712
Mailing Address - Street 2:
Mailing Address - City:MARLIN
Mailing Address - State:TX
Mailing Address - Zip Code:76661-4685
Mailing Address - Country:US
Mailing Address - Phone:254-883-5561
Mailing Address - Fax:
Practice Address - Street 1:742 FM 712
Practice Address - Street 2:
Practice Address - City:MARLIN
Practice Address - State:TX
Practice Address - Zip Code:76661-4685
Practice Address - Country:US
Practice Address - Phone:254-883-5561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17280122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice