Individual
ANITA S. GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2814 BUFORD HWY NE, ATLANTA, 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
1223G0001X
General Practice Dentistry
Primary
9248
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000225299A
—
GA
Enumeration date
02/07/2007
Last updated
10/07/2010
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