Individual
DR. CHARLES G. GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1026 EAGLERIDGE BLVD, PUEBLO, CO 81008-2130
(719) 372-0808
Mailing address
1026 EAGLERIDGE BLVD, PUEBLO, CO 81008-2130
(719) 372-0808
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7308
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02073088
—
CO
Enumeration date
02/22/2006
Last updated
01/12/2011
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