Individual
DR. RANDALL R GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
1420 S MILLS AVE, SUITE G, LODI, CA 95242-4291
(209) 369-1484
(209) 366-0998
Mailing address
1420 S MILLS AVE, SUITE G, LODI, CA 95242-4291
(209) 369-1484
(209) 366-0998
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
40598
CA
Other
Enumeration date
09/20/2006
Last updated
07/08/2007
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