Provider Demographics
NPI:1851462634
Name:GORDON, ANGELA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
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 1:2555 LINCOLN HWY
Mailing Address - Street 2:SUITE 111
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1936
Mailing Address - Country:US
Mailing Address - Phone:888-675-0668
Mailing Address - Fax:708-679-0670
Practice Address - Street 1:2555 LINCOLN HWY
Practice Address - Street 2:SUITE 111
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1936
Practice Address - Country:US
Practice Address - Phone:888-675-0668
Practice Address - Fax:708-679-0670
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0246691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice