Provider Demographics
NPI:1932372547
Name:GORDON DENTAL ASSOCIATES, LTD.
Entity Type:Organization
Organization Name:GORDON DENTAL ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-926-5193
Mailing Address - Street 1:2555 LINCOLN HWY
Mailing Address - Street 2:SUITE 109
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1936
Mailing Address - Country:US
Mailing Address - Phone:708-679-0668
Mailing Address - Fax:708-679-0667
Practice Address - Street 1:2555 LINCOLN HWY
Practice Address - Street 2:SUITE 109
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1936
Practice Address - Country:US
Practice Address - Phone:708-679-0668
Practice Address - Fax:708-679-0667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty