Individual
OLIVIA PORTER GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16690 E MAIN ST, LOUISVILLE, MS 39339-2750
(662) 773-4222
Mailing address
16690 E MAIN ST, LOUISVILLE, MS 39339-2750
(662) 773-4222
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
112695
MS
Other
Enumeration date
05/29/2026
Last updated
05/29/2026
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