Provider Demographics
NPI:1336353085
Name:GORDON, STEPHNEY ELISE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHNEY
Middle Name:ELISE
Last Name:GORDON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 CEDARBROOK CT
Mailing Address - Street 2:
Mailing Address - City:MCMURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-3545
Mailing Address - Country:US
Mailing Address - Phone:724-747-9253
Mailing Address - Fax:
Practice Address - Street 1:2404 OXFORD DR
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-1856
Practice Address - Country:US
Practice Address - Phone:412-851-5060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029683L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics