Gordon Averill, D.M.D

Primary specialty

DentistTaxonomy code 122300000X

License

12810 Issued in NC

Practice address

2435 Plantation Center Dr Ste 100
Matthews, NC 28105-5148

Phone

(704) 847-7426

NPI assigned

Jul 27, 2015

Last updated

Jan 13, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 8, 2021 through Dec 8, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gordon Averill, DMD and Angie Dunkling, DMD Dental Services Inc

  dba 26th Street Dental

  • General Practice Dentistry
  • Santa Monica, CA
  • NPI 1770078248
  NPD Authorized official
• Matthews Dental Care

  • General Practice Dentistry
  • Matthews, NC
  • NPI 1083768600
  NPD (past)
• Anfruns Henderson and Kane Dental Partnership

  dba 26th Street Dental

  • General Practice Dentistry
  • Santa Monica, CA
  • NPI 1588385462
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1437955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673568000000",
    "number": "1043695513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2435 PLANTATION CENTER DR STE 100",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281055148",
            "telephone_number": "704-847-7426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2435 PLANTATION CENTER DR STE 100",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281055148",
            "telephone_number": "704-847-7426"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "990 Paradise Rd",
            "address_purpose": "LOCATION",
            "city": "Swampscott",
            "state": "MA",
            "postal_code": "019071395",
            "country_code": "US",
            "telephone_number": "781-598-3700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AVERILL",
        "first_name": "GORDON",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-27",
        "last_updated": "2023-01-13",
        "certification_date": "2023-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "DDS101899",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NC",
            "license": "12810",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1856859",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043695513",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Vivencio Crisostomo Austero Jr., LDO, ABOC
• Austin Village Eyecare OD PA
• Autumn Coan Austin I, MA, LPC, CSAC
• Alicia Aycock
• Lauren Michelle Aydelette, PHARMD
• Erin Victoria Aylward
• B. Naba, DDS PLLC (Six Sigma Dental Care)
• Alicia Insorn Baccam

• Dentist in Matthews, NC
• Providers in Matthews, NC by specialty
• Dentist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.