Provider Demographics
NPI:1487221719
Name:GORHAM, ANDREW MERRITT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MERRITT
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 1:5425 SYKES RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27856-8325
Mailing Address - Country:US
Mailing Address - Phone:252-955-0697
Mailing Address - Fax:
Practice Address - Street 1:111 CANDLEWOOD RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2130
Practice Address - Country:US
Practice Address - Phone:252-443-2328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC122291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice