Individual
BRANDON D GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7186 SAGE VIEW CR, IDAHO FALLS, ID 83406
(441) 687-1481
Mailing address
7186 SAGE VIEW CR, IDAHO FALLS, ID 83406
(441) 687-1481
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6655977-9922
UT
Other
Enumeration date
07/10/2008
Last updated
07/10/2008
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