Provider Demographics
NPI:1790064376
Name:NORD, GARY ALAN JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALAN
Last Name:NORD
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:127 MESEROLE ST
Mailing Address - Street 2:APT #2B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-2189
Mailing Address - Country:US
Mailing Address - Phone:562-644-4059
Mailing Address - Fax:
Practice Address - Street 1:127 MESEROLE ST
Practice Address - Street 2:APT #2B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-2189
Practice Address - Country:US
Practice Address - Phone:562-644-4059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0556681223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics