Individual
DR. MICHAEL JAY GORDON SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4155 FERNCREEK DR, SUITE 101, FAYETTEVILLE, NC 28314-2581
(910) 323-8899
(910) 486-6524
Mailing address
4325 NORWICK DR, FAYETTEVILLE, NC 28314-2531
(910) 323-8899
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5492
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5492
DELTA RETIRED
NC
01
—
805329
UCCI
NC
Enumeration date
01/25/2007
Last updated
07/08/2007
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