Bruce, Eric Gordon
Bruce, Eric Gordon is an individual health care provider with primary practice located at 1009 Ridgeway Pl Suite 100, Farmington NM 87401-2092. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Bruce, Eric Gordon can be contacted via phone (505) 599-9359.Contact Information
Primary practice address
1009 Ridgeway Pl Suite 100
Farmington NM 87401-2092
Phone: (505) 599-9359
Fax: (505) 599-8177
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | DD2066 | New Mexico |
| Dental Providers / Dentist | 122300000X | H-D-A-04821 | Colorado |
| Dental Providers / Dentist | 122300000X | 4344 | Oklahoma |
Profile Details
| NPI number | 1992765671 |
|---|---|
| LBN Legal business name | Bruce, Eric Gordon |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 25th, 2006 |
| Last updated | Jul 8th, 2007 - about 19 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1992765671 | NPPES |
| New Mexico | MEDICAID | 83327 |
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