Individual
MARIAH GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2050A 2ND ST SE, KIRTLAND AFB, NM 87117-5901
(505) 846-3200
Mailing address
2501 CAPEHART RD, OFFUTT AFB, NE 68113-1043
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DB-2024-0164
NM
Other
Enumeration date
04/24/2024
Last updated
07/16/2025
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