Gordon Keith Wymore, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

MI13678 Issued in MI

Practice address

550 Osborn Blvd
Suite 2603
Sault Sainte Marie, MI 49783-1899

Phone

(906) 635-9303

Fax

(906) 635-9310

NPI assigned

May 1, 2007

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013137025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 OSBORN BLVD",
            "address_2": "SUITE 2603",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497831899",
            "telephone_number": "906-635-9303",
            "fax_number": "906-635-9310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 OSBORN BLVD",
            "address_2": "SUITE 2603",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497831899",
            "telephone_number": "906-635-9303",
            "fax_number": "906-635-9310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYMORE",
        "first_name": "GORDON",
        "middle_name": "KEITH",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "MI13678",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyle Damon Wood, M.S., LLP
• Shane Michael Woolever, D.O.
• Wright & Filippis, Inc.
• Wright & Filippis, Inc.
• Danyalle Marie Wyckoff, NP
• Erin Yates, CSAC, CADC
• Blaine Yoder
• Alexander P Young
• Timothy John Young, PT,DPT
• Presleigh Yovich, FNP-C

• All providers in Sault Sainte Marie, MI
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.