Brenda Jo Gordon, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019020338 Issued in IL

Practice address

141 W Jackson Blvd
#3632
Chicago, IL 60604-2929

Phone

(312) 939-2400

NPI assigned

Sep 26, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Practice roles

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

• Dr. Staci Sikora and Associates

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1174827042
  NPD (past)

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1221177600000",
    "number": "1083715486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 W JACKSON BLVD",
            "address_2": "#3632",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606042929",
            "telephone_number": "312-939-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 W JACKSON BLVD",
            "address_2": "#3632",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606042929",
            "telephone_number": "312-939-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "BRENDA",
        "middle_name": "JO",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-26",
        "last_updated": "2008-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30018904",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "32427",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019020338",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Gordon
• Ayo Henry Gordon, D.C.
• Barbara Jean Gordon, MSN
• Barbara P Gordon
• Bradley Jennings Gordon, M.D.
• Colette Gordon, MD
• Daniel Adam Gordon, LCSW
• Darwin Gordon
• Dawnelle Marie-Vargas Gordon, PMHNP-BC, ARNP, APNP
• Dmitri Gordon

• General Practice Dentistry in Chicago, IL
• Providers in Chicago, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2008; 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.