Individual
DR. JACOB MARTIN GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1021 CEDAR LN, WOODMERE, NY 11598-1211
(516) 569-4653
Mailing address
1021 CEDAR LN, WOODMERE, NY 11598-1211
(516) 569-4653
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
028796
NY
Other
Enumeration date
07/19/2006
Last updated
07/08/2007
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