Provider Demographics
NPI:1760661813
Name:GORDON, DANIELLE D (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:D
Last Name:GORDON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 BLUE HERON BLVD E
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-4545
Mailing Address - Country:US
Mailing Address - Phone:561-848-3462
Mailing Address - Fax:561-848-9522
Practice Address - Street 1:450 NEW MARKET BLVD STE 4
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5501
Practice Address - Country:US
Practice Address - Phone:828-386-1388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN173411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice