Provider Demographics
NPI:1235560574
Name:JOE R. GORHAM DDS,INC.
Entity Type:Organization
Organization Name:JOE R. GORHAM DDS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-388-7416
Mailing Address - Street 1:2222 N PRAIRIE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-8101
Mailing Address - Country:US
Mailing Address - Phone:214-388-7416
Mailing Address - Fax:
Practice Address - Street 1:2222 N PRAIRIE CREEK RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-8101
Practice Address - Country:US
Practice Address - Phone:214-388-7416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7599122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty