Provider Demographics
NPI:1871516088
Name:GORDON, SARA C (DDS)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:C
Last Name:GORDON
Suffix:
Gender:F
Credentials:DDS
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Mailing Address - Street 1:801 S PAULINA ST
Mailing Address - Street 2:UIC COLLEGE OF DENTISTRY, OMDS (MC838)
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7210
Mailing Address - Country:US
Mailing Address - Phone:312-996-1104
Mailing Address - Fax:312-996-9226
Practice Address - Street 1:801 S PAULINA STREET
Practice Address - Street 2:DEPT OF ORAL MEDICINE UIC COLLEGE OF DENTISTRY MC 838
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7213
Practice Address - Country:US
Practice Address - Phone:312-996-1104
Practice Address - Fax:312-996-9226
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2009-04-10
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Provider Licenses
StateLicense IDTaxonomies
MI29010172791223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology