Provider Demographics
NPI:1881855088
Name:GORDONA, JENNIFER WILLIAMSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:WILLIAMSON
Last Name:GORDONA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:ERIN
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:105 E OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-3528
Mailing Address - Country:US
Mailing Address - Phone:740-392-1111
Mailing Address - Fax:
Practice Address - Street 1:105 E OHIO AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-3528
Practice Address - Country:US
Practice Address - Phone:740-392-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0228131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice