Provider Demographics
NPI:1790858850
Name:GORDON, NICOLE HELEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:HELEN
Last Name:GORDON
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:PO BOX 4680
Mailing Address - Street 2:
Mailing Address - City:STATELINE
Mailing Address - State:NV
Mailing Address - Zip Code:89449-4680
Mailing Address - Country:US
Mailing Address - Phone:775-580-7410
Mailing Address - Fax:775-580-7308
Practice Address - Street 1:276 KINGSBURY GRADE
Practice Address - Street 2:
Practice Address - City:STATELINE
Practice Address - State:NV
Practice Address - Zip Code:89449-9804
Practice Address - Country:US
Practice Address - Phone:775-580-7410
Practice Address - Fax:775-580-7308
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA539701223G0001X
NV71491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice