Gordon, Mark J

Gordon, Mark J is an individual health care provider with primary practice located at 4121 W 83Rd St Suite 212, Prairie Village KS 66208-5300. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Gordon, Mark J can be contacted via phone (913) 649-4042.

Contact Information

Primary practice address
4121 W 83Rd St Suite 212 Prairie Village KS 66208-5300
Phone: (913) 649-4042
Fax: (913) 649-8898
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 5900 Kansas
Dental Providers / Dentist 122300000X 013474 Missouri

Profile Details

NPI number 1386643740
LBN Legal business name Gordon, Mark J
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 19th, 2005
Last updated Jul 8th, 2007 - about 18 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 1386643740 NPPES
Missouri Other 09533-01-8 BCBS
Missouri Other 79345 BCBS

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