Provider Demographics
NPI:1013123470
Name:GORDON, NICOLE THORNTON (DMD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:THORNTON
Last Name:GORDON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:691 ALDERMAN RD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-2602
Mailing Address - Country:US
Mailing Address - Phone:727-724-4227
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST FL 1
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-2602
Practice Address - Country:US
Practice Address - Phone:859-323-5831
Practice Address - Fax:859-257-3366
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17664122300000X
KY11188122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist