Provider Demographics
NPI:1518947514
Name:ROZNIK, GORDON JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:JOSEPH
Last Name:ROZNIK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 SOUTH KINGS DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28285
Mailing Address - Country:US
Mailing Address - Phone:704-375-2880
Mailing Address - Fax:704-375-3470
Practice Address - Street 1:400 SOUTH TRYON STREET
Practice Address - Street 2:STE M4A LOBBY LEVEL
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28285
Practice Address - Country:US
Practice Address - Phone:704-375-7711
Practice Address - Fax:704-375-3470
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6775122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist