Individual
BRIAN KEITH GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12315200-9921
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0401419116
DENTAL LICENSE
VA
01
—
12315200-9921
DENTAL LICENSE
UT
Enumeration date
07/22/2021
Last updated
07/23/2024
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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