Provider Demographics
NPI:1235261991
Name:GORDAY, MICHAEL STEVEN (DDS, MHS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STEVEN
Last Name:GORDAY
Suffix:
Gender:M
Credentials:DDS, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 HIGH ROCK ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-3428
Mailing Address - Country:US
Mailing Address - Phone:210-495-0427
Mailing Address - Fax:210-495-3068
Practice Address - Street 1:1100 NW LOOP 410
Practice Address - Street 2:505
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2263
Practice Address - Country:US
Practice Address - Phone:210-341-6023
Practice Address - Fax:210-341-7332
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX128351223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU15200Medicare UPIN