Provider Demographics
NPI:1154336956
Name:GORK, STEPHEN E (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:E
Last Name:GORK
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 1:26771 W 12 MILE RD
Mailing Address - Street 2:SUITE G-115
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1539
Mailing Address - Country:US
Mailing Address - Phone:248-353-7440
Mailing Address - Fax:248-353-3148
Practice Address - Street 1:26771 W 12 MILE RD
Practice Address - Street 2:SUITE G-115
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1539
Practice Address - Country:US
Practice Address - Phone:248-353-7440
Practice Address - Fax:248-353-3148
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID12696041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice