Individual
DR. JEREMIAH DANIEL GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
135 JENKINS ST, SUITE 105A, ST AUGUSTINE, FL 32086-5175
(904) 460-0999
(904) 460-0999
Mailing address
53 WILLOW DR, ST AUGUSTINE, FL 32080-5936
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN16348
FL
Other
Enumeration date
03/20/2007
Last updated
02/11/2009
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