Dr. Andrea T. Gordon DDS,LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

013689 Issued in MO

Legal business name

DR. ANDREA T. GORDON DDS,LLC

Practice address

1408 N Kingshighway Blvd
Saint Louis, MO 63113-1400

Phone

(314) 361-6767

Fax

(314) 361-1480

NPI assigned

Feb 29, 2012

Last updated

Feb 29, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Andrea T. Gordon, D.D.S.NPI 1295725992

Title

Dentist

Phone

(314) 361-6767

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Andrea Thomas Gordon, D.D.S.

  • General Practice Dentistry
  • Saint Louis, MO
  • NPI 1295725992
  Authorized official Same address or phone

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

{
    "created_epoch": "1330473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330473600000",
    "number": "1073887642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1408 N KINGSHIGHWAY BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631131400",
            "telephone_number": "314-361-6767",
            "fax_number": "314-361-1480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1408 N KINGSHIGHWAY BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631131400",
            "telephone_number": "314-361-6767",
            "fax_number": "314-361-1480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. ANDREA T. GORDON DDS,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-29",
        "last_updated": "2012-02-29",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "314-361-6767",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "013689",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "401900311",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "979390",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAQUEST",
            "identifier": "3051",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2012; 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.