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Provider Information for 1083612071

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

MR. SCOTT THOMAS GORDON DDS

Gender: MALE

Individual NPI: 1083612071

Calendar   Last Updated:  2007-07-08
  Certification Date: 

Details

Name Value
NPI 1083612071
Enumeration Date 2005-07-13
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 3905 RR 620 N
AUSTIN, TX 78734-2120
United States

Phone: 512-266-1308 | Fax: 512-266-7024
View Map External Link
Primary Practice Address 3905 RR 620 N
AUSTIN, TX 78734-2120
United States

Phone: 512-266-1308 | Fax: 512-266-7024
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist TX 19423