Provider Demographics
NPI:1952422560
Name:GORDON, JOHN ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
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 1:5901 NW 63RD TER
Mailing Address - Street 2:SUITE150
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-3319
Mailing Address - Country:US
Mailing Address - Phone:816-505-2222
Mailing Address - Fax:816-505-1337
Practice Address - Street 1:5901 NW 63RD TER
Practice Address - Street 2:SUITE150
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-3319
Practice Address - Country:US
Practice Address - Phone:816-505-2222
Practice Address - Fax:816-505-1337
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO129061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice