Provider Demographics
NPI:1902012792
Name:DR. WILLIAM H. GORDON, D.D.S., P.A.
Entity Type:Organization
Organization Name:DR. WILLIAM H. GORDON, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:K
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-383-6661
Mailing Address - Street 1:1904 FRONT ST
Mailing Address - Street 2:STE 530
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2583
Mailing Address - Country:US
Mailing Address - Phone:919-383-6661
Mailing Address - Fax:919-384-1991
Practice Address - Street 1:1904 FRONT ST
Practice Address - Street 2:STE 530
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2583
Practice Address - Country:US
Practice Address - Phone:919-383-6661
Practice Address - Fax:919-384-1991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3789261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental