# GORDON D. GROSS, D.D.S.,P.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Northern Avenue Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548482300
- **Authorized official:** DR. GORDON D GROSS D.D.S. (OWNER)
- **Authorized official phone:** (602) 995-0280

## Contact information

- **Practice address:** 2715 W NORTHERN AVE, \#102, PHOENIX, AZ 85051-6641
- **Practice address phone:** (602) 995-0280
- **Practice address fax:** (602) 864-9161
- **Mailing address:** 2715 W NORTHERN AVE, \#102, PHOENIX, AZ 85051-6641
- **Mailing address phone:** (602) 995-0280
- **Mailing address fax:** (602) 864-9161

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/02/2007
- **Last updated:** 08/22/2020