Organization
GORDON D. GROSS, D.D.S.,P.C.
Active
Other names
Northern Avenue Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GORDON D GROSS D.D.S. (OWNER)
(602) 995-0280
Entity
Organization
Contact information
Practice address
2715 W NORTHERN AVE, #102, PHOENIX, AZ 85051-6641
(602) 995-0280
(602) 864-9161
Mailing address
2715 W NORTHERN AVE, #102, PHOENIX, AZ 85051-6641
(602) 995-0280
(602) 864-9161
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
824144
UNITED CONCORDIA
AZ
Enumeration date
05/02/2007
Last updated
08/22/2020
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