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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1831164722 NPPES
Colorado MEDICAID 02073088

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