Organization
GORDON ORTHODONTICS, INC.
Active
Organization
GORDON ORTHODONTICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM M GORDON DMD (ORTHODONTIST)
(401) 828-1171
Entity
Organization
Contact information
Practice address
840 TIOGUE AVE, COVENTRY, RI 02816-5914
(401) 828-1171
(401) 828-4704
Mailing address
840 TIOGUE AVE, COVENTRY, RI 02816-5914
(401) 828-1171
(401) 828-4704
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
2421
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8607-7
BLUE CROSS DENTAL OF RHODE ISLAND
RI
01
—
WG00555
MEDICAL ASSISTANCE
RI
Enumeration date
08/20/2008
Last updated
01/31/2011
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