Active NPI
Kristyn Kacie Gordon, DMD
- Dentist
- Portland, ME
National Provider Identifier
1205629243
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DMD5252
- Practice address
- 117 Auburn St
Portland, ME 04103-6003 - Phone
- (207) 808-9498
- NPI assigned
- May 23, 2025
- Sex
- Female
- Sole proprietor
- No
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 | DMD5252 | ME | Primary |
Addresses
Primary practice location
117 Auburn St
Portland, ME 04103-6003
Mailing address
225 Main St Unit 433
Saco, ME 04072-7018
Phone (978) 602-4422
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 |
|---|---|---|---|
| DMD5252 | ME | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1747958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747958400000",
"number": "1205629243",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "225 MAIN ST UNIT 433",
"city": "SACO",
"state": "ME",
"postal_code": "040727018",
"telephone_number": "978-602-4422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "117 AUBURN ST",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041036003",
"telephone_number": "207-808-9498"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "KRISTYN",
"middle_name": "KACIE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-05-23",
"last_updated": "2025-05-23",
"certification_date": "2025-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "ME",
"license": "DMD5252",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.