Individual
MARK J GORDON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4121 W 83RD ST, SUITE 212, PRAIRIE VILLAGE, KS 66208-5300
(913) 649-4042
(913) 649-8898
Mailing address
4121 W 83RD ST, SUITE 212, PRAIRIE VILLAGE, KS 66208-5300
(913) 649-4042
(913) 649-8898
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
013474
MO
122300000X
Dentist
Primary
5900
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09533-01-8
BCBS
MO
01
—
79345
BCBS
KS
Enumeration date
07/19/2005
Last updated
07/08/2007
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