Provider Demographics
NPI:1225265010
Name:GORDON, PHILIP J (DDS)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:J
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 1:5844 NW BARRY RD
Mailing Address - Street 2:STE. 220
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-1465
Mailing Address - Country:US
Mailing Address - Phone:816-505-2222
Mailing Address - Fax:816-505-1334
Practice Address - Street 1:5844 NW BARRY RD
Practice Address - Street 2:STE. 220
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-1465
Practice Address - Country:US
Practice Address - Phone:816-505-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009013194122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist