Gordon Phillip Smith, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

013824 Issued in MI

Practice address

3255 W Maple Rd
Wixom, MI 48393-1820

Phone

(248) 669-4141

NPI assigned

May 26, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1117065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073516712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3255 W MAPLE RD",
            "city": "WIXOM",
            "state": "MI",
            "postal_code": "483931820",
            "telephone_number": "248-669-4141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3255 W MAPLE RD",
            "city": "WIXOM",
            "state": "MI",
            "postal_code": "483931820",
            "telephone_number": "248-669-4141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "GORDON",
        "middle_name": "PHILLIP",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-05-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "013824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelly Ann Siegel, MA-CCC/SLP
• Megan M Silverman, LMSW
• John Slindee, RPH
• James Earl Smart, R.PH.
• Judith Ann Smiley, LLPC
• Denise Latrice Spears, LPN
• Emily Elizabeth Springstube
• Kayla Standridge
• Stay in Motion PT PLLC
• Kyra Strachan

• General Practice Dentistry in Wixom, MI
• Providers in Wixom, MI by specialty
• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.