Individual
DR. LESLIE R GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
814 JEFFERSON AVE, MEMPHIS, TN 38105-5041
(901) 544-7597
(901) 544-7602
Mailing address
3240 RIVER VALLEY LN, MEMPHIS, TN 38119-8090
(901) 544-7600
(901) 544-7602
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS8483
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DS8483
DENTIST LICENSE
TN
Enumeration date
04/11/2007
Last updated
07/08/2007
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