Provider Demographics
NPI:1740393230
Name:GORMAN, MONA ELISABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONA
Middle Name:ELISABETH
Last Name:GORMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 YORK RD
Mailing Address - Street 2:STE 204
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2276
Mailing Address - Country:US
Mailing Address - Phone:410-453-0710
Mailing Address - Fax:410-561-7194
Practice Address - Street 1:2300 YORK RD
Practice Address - Street 2:STE 204
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2276
Practice Address - Country:US
Practice Address - Phone:410-453-0710
Practice Address - Fax:410-561-7194
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11232122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist