Michael Gordon, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DN4096 Issued in FL

Practice address

3706 N Roosevelt Blvd
Suite a
Key West, FL 33040-4566

Phone

(305) 332-4168

Fax

(305) 735-4041

NPI assigned

Oct 17, 2014

Last updated

Oct 17, 2014By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lee Dental Group, Inc.

  • Dental Clinic/Center
  • Key West, FL
  • NPI 1669014502
  NPD (past)

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

{
    "created_epoch": "1413504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413504000000",
    "number": "1184028391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3706 N ROOSEVELT BLVD",
            "address_2": "SUITE A",
            "city": "KEY WEST",
            "state": "FL",
            "postal_code": "330404566",
            "telephone_number": "305-332-4168",
            "fax_number": "305-735-4041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3706 N ROOSEVELT BLVD",
            "address_2": "SUITE A",
            "city": "KEY WEST",
            "state": "FL",
            "postal_code": "330404566",
            "telephone_number": "305-332-4168",
            "fax_number": "305-735-4041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "MICHAEL",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-10-17",
        "last_updated": "2014-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN4096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Harold Gollish, M.D.
• Alexandra Gomez, ARNP
• Eduardo R Gonzalez-Blanco, M.D.
• Good Health Outcomes, Inc.
• Bryna Gordon
• Jennifer Grace, LCSW
• Lisa Graft, RN
• Stephen M Graniela, LMT
• Elizabeth Graves
• Jjay D Grazette, PT ASPT HT

• Dentist in Key West, FL
• Providers in Key West, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2014; 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.