Provider Demographics
NPI:1710998570
Name:LUKE, GORDON W (DDS)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:W
Last Name:LUKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 W MARCH LN
Mailing Address - Street 2:SUITE 240
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-8252
Mailing Address - Country:US
Mailing Address - Phone:209-478-3079
Mailing Address - Fax:
Practice Address - Street 1:2509 W MARCH LN
Practice Address - Street 2:SUITE 240
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-8252
Practice Address - Country:US
Practice Address - Phone:209-478-3079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA276481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice