Provider Demographics
NPI:1407002744
Name:GORHAM, J. CHRIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:CHRIS
Last Name:GORHAM
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 1:2000 IH 35 S
Mailing Address - Street 2:SUITE K-1
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-6900
Mailing Address - Country:US
Mailing Address - Phone:512-255-7839
Mailing Address - Fax:
Practice Address - Street 1:2000 IH 35 S
Practice Address - Street 2:SUITE K-1
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-6900
Practice Address - Country:US
Practice Address - Phone:512-255-7839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice