Provider Demographics
NPI:1780140186
Name:GORDON FAMILY DENTAL
Entity type:Organization
Organization Name:GORDON FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-766-6344
Mailing Address - Street 1:1020 S 1100 W STE A
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-6040
Mailing Address - Country:US
Mailing Address - Phone:801-766-6344
Mailing Address - Fax:801-766-6881
Practice Address - Street 1:1020 S 1100 W STE A
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-6040
Practice Address - Country:US
Practice Address - Phone:801-766-6344
Practice Address - Fax:801-766-6881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare