Organization
DR DONALD R GORDON & ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD R GORDON D.D.S. (PRESIDENT)
(484) 485-7156
Entity
Organization
Contact information
Practice address
3 PINE TREE DR, BROOMALL, PA 19008-2740
(484) 485-7156
Mailing address
3 PINE TREE DR, BROOMALL, PA 19008-2740
(484) 485-7156
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS017817L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0032775000
INDEPENDENCE BLUE CROSS
PA
01
—
2633
AETNA
PA
Enumeration date
03/27/2007
Last updated
11/20/2009
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