Provider Demographics
NPI:1952339772
Name:GORDON, MILTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35100 TIFFANY DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-3549
Mailing Address - Country:US
Mailing Address - Phone:586-264-3800
Mailing Address - Fax:586-264-3802
Practice Address - Street 1:35100 TIFFANY DR
Practice Address - Street 2:SUITE 103
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-3549
Practice Address - Country:US
Practice Address - Phone:586-264-3800
Practice Address - Fax:586-264-3802
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010086811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics