Organization
DR. ANDREA T. GORDON DDS,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREA T. GORDON D.D.S. (DENTIST)
(314) 361-6767
Entity
Organization
Contact information
Practice address
1408 N KINGSHIGHWAY BLVD, SAINT LOUIS, MO 63113-1400
(314) 361-6767
(314) 361-1480
Mailing address
1408 N KINGSHIGHWAY BLVD, SAINT LOUIS, MO 63113-1400
(314) 361-6767
(314) 361-1480
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
013689
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3051
DENTAQUEST
MO
05
—
401900311
—
MO
01
—
979390
UNITED CONCORDIA
MO
Enumeration date
02/29/2012
Last updated
02/29/2012
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