Provider Demographics
NPI:1396362638
Name:PHILIP J GORDON DDS PA
Entity Type:Organization
Organization Name:PHILIP J GORDON DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-649-5017
Mailing Address - Street 1:3628 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-2035
Mailing Address - Country:US
Mailing Address - Phone:913-649-5017
Mailing Address - Fax:913-661-7186
Practice Address - Street 1:3628 W 95TH ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66206-2035
Practice Address - Country:US
Practice Address - Phone:913-649-5017
Practice Address - Fax:913-661-7186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty