Provider Demographics
NPI:1659368504
Name:GORDON G. WILLIAMSON, DDS, PC
Entity Type:Organization
Organization Name:GORDON G. WILLIAMSON, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-933-5749
Mailing Address - Street 1:14800 W MOUNTAIN VIEW BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-4795
Mailing Address - Country:US
Mailing Address - Phone:623-933-5749
Mailing Address - Fax:623-815-1220
Practice Address - Street 1:14800 W MOUNTAIN VIEW BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-4795
Practice Address - Country:US
Practice Address - Phone:623-933-5749
Practice Address - Fax:623-815-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty