Gordon, Charles G.
Gordon, Charles G. is an sole proprietor health care provider with primary practice located at 1026 Eagleridge Blvd , Pueblo CO 81008-2130. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Gordon, Charles G. can be contacted via phone (719) 372-0808.Contact Information
Primary practice address
1026 Eagleridge Blvd
Pueblo CO 81008-2130
Phone: (719) 372-0808
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 7308 | Colorado |
Profile Details
| NPI number | 1831164722 |
|---|---|
| LBN Legal business name | Gordon, Charles G. |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 22nd, 2006 |
| Last updated | Jan 12th, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1831164722 | NPPES |
| Colorado | MEDICAID | 02073088 |
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