Organization
CHARLES GGORDON DDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES GORDON DDS (DENTIST)
(719) 544-7672
Entity
Organization
Contact information
Practice address
1026 EAGLERIDGE BLVD, PUEBLO, CO 81008-2130
(719) 544-7672
Mailing address
1026 EAGLERIDGE BLVD, PUEBLO, CO 81008-2130
(719) 544-7672
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7308
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02073088
—
CO
Enumeration date
01/28/2015
Last updated
01/28/2015
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