Gordon, Jay T

Gordon, Jay T is an individual health care provider with primary practice located at 3004 H G Mosley Pkwy , Longview TX 75605-2948. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Gordon, Jay T can be contacted via phone (903) 758-3444.

Contact Information

Primary practice address
3004 H G Mosley Pkwy Longview TX 75605-2948
Phone: (903) 758-3444
Fax: (903) 758-1967
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 10700 Texas

Profile Details

NPI number 1063594042
LBN Legal business name Gordon, Jay T
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 19th, 2006
Last updated Aug 12th, 2009 - about 15 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 1063594042 NPPES
Texas MEDICAID 130584906
Texas Other 89T820

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