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Organization
PETRA GORDON DMD PLLC
Active
Organization
PETRA GORDON DMD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETRA G LEE DMD (OWNER)
(352) 796-2034
Entity
Organization
Contact information
Practice address
609 LAMAR AVE, BROOKSVILLE, FL 34601-3211
(352) 796-2034
(888) 581-9789
Mailing address
609 LAMAR AVE, BROOKSVILLE, FL 34601-3211
(352) 796-2034
(888) 581-9789
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN 17627
FL
Other
Enumeration date
04/29/2015
Last updated
04/29/2015
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