Provider Demographics
NPI:1013094135
Name:GORDON, LEONEED (DDS)
Entity Type:Individual
Prefix:
First Name:LEONEED
Middle Name:
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 1:1745 WEST AVENUE K, SUITE C
Mailing Address - Street 2:SUITE C
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534
Mailing Address - Country:US
Mailing Address - Phone:661-723-5400
Mailing Address - Fax:661-723-3944
Practice Address - Street 1:2205 E PALMDALE BLVD
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550
Practice Address - Country:US
Practice Address - Phone:661-273-1333
Practice Address - Fax:661-273-1687
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3293601122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist