Provider Demographics
NPI:1659385714
Name:GORDON, DAVID PAUL (DMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PAUL
Last Name:GORDON
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 1:1020 S. 1100 W. SUITE A
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043
Mailing Address - Country:US
Mailing Address - Phone:801-766-6344
Mailing Address - Fax:801-766-6881
Practice Address - Street 1:1020 S 1100 W
Practice Address - Street 2:SUITE A
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-1903
Practice Address - Country:US
Practice Address - Phone:801-766-6344
Practice Address - Fax:801-766-6881
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT62516291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice