Provider Demographics
NPI:1730078841
Name:GORDON, CHASE DONAVON (DDS)
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:DONAVON
Last Name:GORDON
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 1:1320 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-3949
Mailing Address - Country:US
Mailing Address - Phone:409-727-6453
Mailing Address - Fax:409-722-4322
Practice Address - Street 1:1320 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-3949
Practice Address - Country:US
Practice Address - Phone:409-727-6453
Practice Address - Fax:409-722-4322
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX416191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice