Provider Demographics
NPI:1518122738
Name:GORDON, SHERRY DODSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:DODSON
Last Name:GORDON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10331 MEMORY LANE
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-8812
Mailing Address - Country:US
Mailing Address - Phone:804-748-6677
Mailing Address - Fax:804-748-7080
Practice Address - Street 1:10331 MEMORY LN
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-8812
Practice Address - Country:US
Practice Address - Phone:804-748-6677
Practice Address - Fax:804-748-7080
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010073551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice