Provider Demographics
NPI:1326030990
Name:GORDON, JOHN RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RAY
Last Name:GORDON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:3814 CORRAL CANYON RD
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-2806
Mailing Address - Country:US
Mailing Address - Phone:619-267-1662
Mailing Address - Fax:
Practice Address - Street 1:2655 CAMINO DEL RIO N STE 140
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1633
Practice Address - Country:US
Practice Address - Phone:619-282-7088
Practice Address - Fax:619-282-6290
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA518781223S0112X
LA41831223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery