Provider Demographics
NPI:1720224074
Name:NICOLE T GORDON, DMD, PLC
Entity Type:Organization
Organization Name:NICOLE T GORDON, DMD, PLC
Other - Org Name:GORDON DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:T
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:727-724-4227
Mailing Address - Street 1:1301 ENISWOOD PKWY
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-2027
Mailing Address - Country:US
Mailing Address - Phone:727-724-4227
Mailing Address - Fax:
Practice Address - Street 1:691 ALDERMAN RD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-2602
Practice Address - Country:US
Practice Address - Phone:727-724-4227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL263787324261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental