Provider Demographics
NPI:1588812960
Name:GORDON AND RAMIREZ DENTISTRY PARTNERSHIP
Entity Type:Organization
Organization Name:GORDON AND RAMIREZ DENTISTRY PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:KONDRACKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-983-9003
Mailing Address - Street 1:3990 SHERIDAN ST
Mailing Address - Street 2:#216
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3661
Mailing Address - Country:US
Mailing Address - Phone:954-983-9003
Mailing Address - Fax:954-987-2098
Practice Address - Street 1:3990 SHERIDAN ST
Practice Address - Street 2:#216
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3661
Practice Address - Country:US
Practice Address - Phone:954-983-9003
Practice Address - Fax:954-987-2098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1154415255OtherDENTAL PRACTICE
FL1780778894OtherDENTAL PRACTICE