Individual
MORGAN GONDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3615 S HOUSTON LEVEE RD STE 104, COLLIERVILLE, TN 38017-9173
(901) 850-5874
Mailing address
PO BOX 1218, OXFORD, MS 38655-1218
(662) 234-4822
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
4108-20
MS
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DS0000011182
TN
Other
Enumeration date
06/16/2016
Last updated
04/21/2021
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