Provider Demographics
NPI:1821058314
Name:GORDON, TERRY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:M
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 1:1225 CARLISLE ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1207
Mailing Address - Country:US
Mailing Address - Phone:717-632-1332
Mailing Address - Fax:270-637-0207
Practice Address - Street 1:1225 CARLISLE ST STE 1B
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331
Practice Address - Country:US
Practice Address - Phone:717-632-1332
Practice Address - Fax:270-637-0207
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS02485L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6734700001Medicare NSC