| Charles G Gordon Dds Llc | |
|
1026 Eagleridge Blvd Pueblo CO 81008-2130 | |
| (719) 544-7672 | |
| Not Available |
| Full Name | Charles G Gordon Dds Llc |
|---|---|
| Speciality | Dentist |
| Location | 1026 Eagleridge Blvd, Pueblo, Colorado |
| Authorized Official Name and Position | Charles Gordon (MEMBER) |
| Authorized Official Contact | 7195447672 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Charles G Gordon Dds Llc 1026 Eagleridge Blvd Pueblo CO 81008-2130 Ph: (719) 544-7672 | Charles G Gordon Dds Llc 1026 Eagleridge Blvd Pueblo CO 81008-2130 Ph: (719) 544-7672 |
| NPI Number | 1588112726 |
|---|---|
| Provider Enumeration Date | 09/16/2016 |
| Last Update Date | 09/23/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588112726 | NPI | - | NPPES |
| 02073088 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 7308 (Colorado) | Primary |
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