Provider Demographics
NPI:1659583458
Name:GORDON, ERIC M (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:M
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 1:225 STATE ROUTE 35 STE 106
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5919
Mailing Address - Country:US
Mailing Address - Phone:732-741-7333
Mailing Address - Fax:732-741-7336
Practice Address - Street 1:225 STATE ROUTE 35 STE 106
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5919
Practice Address - Country:US
Practice Address - Phone:732-741-7333
Practice Address - Fax:732-741-7336
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ147701223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics