1568598951 NPI number — DR. ROBERT WILLIAM GORDON DDS PC

Table of content: DR. ROBERT WILLIAM GORDON DDS PC (NPI 1568598951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568598951 NPI number — DR. ROBERT WILLIAM GORDON DDS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GORDON
Provider First Name:
ROBERT
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS PC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568598951
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3633 WEST LAKE AVE
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
GLENVIEW
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-729-4747
Provider Business Mailing Address Fax Number:
847-729-7747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3633 WEST LAKE AVE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
GLENVIEW
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-729-4747
Provider Business Practice Location Address Fax Number:
847-729-7747
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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