Provider Demographics
NPI:1164448171
Name:GORDON, PAUL E (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:E
Last Name:GORDON
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 S BEDFORD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-5154
Mailing Address - Country:US
Mailing Address - Phone:781-272-0800
Mailing Address - Fax:781-272-0806
Practice Address - Street 1:77 S BEDFORD ST STE 100
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-5154
Practice Address - Country:US
Practice Address - Phone:781-272-0800
Practice Address - Fax:781-272-0806
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA84241223S0112X
MA246483204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery