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Organization
ANITA S. GODON DDS
Active
Organization
ANITA S. GODON DDS
Active
Other names
Gordon Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
ANITA GORDON DDS (OWNER)
(404) 486-7661
Entity
Organization
Contact information
Practice address
2814 BUFORD HWY NE, BROOKHAVEN, GA 30329-2103
(404) 486-7661
(404) 486-7662
Mailing address
PO BOX 29411, ATLANTA, GA 30359-0411
(404) 486-7661
(404) 486-7662
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN009248
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000225299A
—
GA
05
—
00809278A
—
GA
Enumeration date
08/28/2015
Last updated
08/28/2015
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