Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 6044 | MD |
NPI | 1003833518 |
---|---|
Provider Name | Dr. James Gregory Gordon |
First Address | Upperco, MD 21155 |
Second Address | Pikesville, MD 21208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 08/07/2007 |