Active NPI
Christina Beausoleil Gordon, DDS
- Dentist
- Richmond, VA
National Provider Identifier
1164108213
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0442000498
- Practice address
- 520 N 12TH St RM 111
Richmond, VA 23298-5064 - Phone
- (804) 828-0843
- NPI assigned
- Jun 23, 2023
- Last updated
- Jun 23, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0442000498 | VA | Primary |
Addresses
Primary practice location
520 N 12TH St RM 111
Richmond, VA 23298-5064
Mailing address
1821 Mactavish Ave Apt 2145
Richmond, VA 23230-4335
Phone (214) 205-7105
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0442000498 | VA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687478400000",
"number": "1164108213",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1821 MACTAVISH AVE APT 2145",
"city": "RICHMOND",
"state": "VA",
"postal_code": "232304335",
"telephone_number": "214-205-7105"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "520 N 12TH ST RM 111",
"city": "RICHMOND",
"state": "VA",
"postal_code": "232985064",
"telephone_number": "804-828-0843"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "CHRISTINA",
"middle_name": "BEAUSOLEIL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-06-23",
"last_updated": "2023-06-23",
"certification_date": "2023-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0442000498",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richmond, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.