Provider Demographics
NPI:1336211473
Name:GORDON, STANLEY MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:MARK
Last Name:GORDON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:STANLEY
Other - Middle Name:M
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS PA
Mailing Address - Street 1:7651 SW ST RD 200
Mailing Address - Street 2:UNIT 101
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476
Mailing Address - Country:US
Mailing Address - Phone:352-854-2000
Mailing Address - Fax:
Practice Address - Street 1:7651 SW ST RD 200
Practice Address - Street 2:UNIT 101
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476
Practice Address - Country:US
Practice Address - Phone:352-854-2000
Practice Address - Fax:352-854-6509
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN9088122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist