Provider Demographics
NPI:1184990848
Name:POCIALIK, GORDON PAUL (DMD, MS)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:PAUL
Last Name:POCIALIK
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 N COLLIER BLVD
Mailing Address - Street 2:STE #305
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-2725
Mailing Address - Country:US
Mailing Address - Phone:239-389-9400
Mailing Address - Fax:
Practice Address - Street 1:950 N COLLIER BLVD
Practice Address - Street 2:STE #305
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-2725
Practice Address - Country:US
Practice Address - Phone:239-389-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL018001842122300000X
FLDN20442122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist