Organization
CHARLES G GORDON DDS LLC
Active
Parent organization
CHARLES GORDON DDS LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHARLES GORDON DDS LLC
Authorized official
CHARLES GORDON (MEMBER)
(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
09/16/2016
Last updated
09/23/2016
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