Provider Demographics
NPI:1881729820
Name:GORDON, JACQUES LENOEL (DMD)
Entity type:Individual
Prefix:DR
First Name:JACQUES
Middle Name:LENOEL
Last Name:GORDON
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:3885 PRINCETON LAKES WAY SW
Mailing Address - Street 2:STE 408
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-5589
Mailing Address - Country:US
Mailing Address - Phone:404-629-6610
Mailing Address - Fax:404-629-6630
Practice Address - Street 1:3885 PRINCETON LAKES WAY SW
Practice Address - Street 2:STE 408
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5589
Practice Address - Country:US
Practice Address - Phone:404-629-6610
Practice Address - Fax:404-629-6630
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2010-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GADN0134631223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery