Provider Demographics
NPI:1477735637
Name:ZORN, GORDON JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:JOHN
Last Name:ZORN
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 1:17121 YORK RD
Mailing Address - Street 2:
Mailing Address - City:PARKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21120-9718
Mailing Address - Country:US
Mailing Address - Phone:410-329-6866
Mailing Address - Fax:410-343-0602
Practice Address - Street 1:17121 YORK RD
Practice Address - Street 2:
Practice Address - City:PARKTON
Practice Address - State:MD
Practice Address - Zip Code:21120-9718
Practice Address - Country:US
Practice Address - Phone:410-329-6866
Practice Address - Fax:410-343-0602
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD61931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice