Provider Demographics
NPI:1720322852
Name:GORDON, JONATHAN (PHARMD, DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:PHARMD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7345 BRISTOL CIR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-0696
Mailing Address - Country:US
Mailing Address - Phone:678-200-0569
Mailing Address - Fax:
Practice Address - Street 1:1250 GARTH RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-2423
Practice Address - Country:US
Practice Address - Phone:832-572-5820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13654183500000X
TX395331223G0001X
GA024929183500000X
FLDN23865122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No183500000XPharmacy Service ProvidersPharmacist
No1223G0001XDental ProvidersDentistGeneral Practice