Provider Demographics
NPI:1376077040
Name:GORDON, TONI-ANNE T (DMD)
Entity Type:Individual
Prefix:
First Name:TONI-ANNE
Middle Name:T
Last Name:GORDON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:TONI-ANNE
Other - Middle Name:T
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:11250 POINT SYLVAN CIR APT H
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-6054
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:840 MERCY DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-7820
Practice Address - Country:US
Practice Address - Phone:407-905-8827
Practice Address - Fax:407-660-1667
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2020-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21870122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist