Organization
ANITA S. GODON DDS
Active
Other names
Gordon Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
ANITA GORDON DDS (OWNER)
(404) 486-7661
Entity
Organization
Contact information
Practice address
2814 BUFORD HWY NE, BROOKHAVEN, GA 30329-2103
(404) 486-7661
(404) 486-7662
Mailing address
PO BOX 29411, ATLANTA, GA 30359-0411
(404) 486-7661
(404) 486-7662
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN009248
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000225299A
—
GA
05
—
00809278A
—
GA
Enumeration date
08/28/2015
Last updated
08/28/2015
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