Individual
DR. MARK RICHARD GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
305 W 12TH AVE, COLUMBUS, OH 43210-1267
(614) 688-3763
Mailing address
305 W 12TH AVE, COLUMBUS, OH 43210-1267
(614) 688-3763
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
14332
OH
1223P0300X
Periodontics
14432
OH
1223P0300X
Periodontics
VA6393
VA
Other
Enumeration date
07/26/2006
Last updated
11/28/2020
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