Active NPI
Wanda Celeste Gordon, DMD
- Endodontics
- Philadelphia, PA
National Provider Identifier
1215184692
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- DS024105L
- Practice address
- 3223 N Broad St
Department of Endodontics
Philadelphia, PA 19140-5007 - Phone
- (215) 707-4428
- Fax
- (215) 707-1482
- NPI assigned
- Aug 27, 2008
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | DS024105L | PA | Primary |
Addresses
Primary practice location
3223 N Broad St
Department of Endodontics
Philadelphia, PA 19140-5007
Mailing address
3223 N Broad St
Department of Endodontics
Philadelphia, PA 19140-5007
Phone (215) 707-4428
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS024105L | PA | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219795200000",
"number": "1215184692",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3223 N BROAD ST",
"address_2": "DEPARTMENT OF ENDODONTICS",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191405007",
"telephone_number": "215-707-4428",
"fax_number": "215-707-1482"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3223 N BROAD ST",
"address_2": "DEPARTMENT OF ENDODONTICS",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191405007",
"telephone_number": "215-707-4428",
"fax_number": "215-707-1482"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "WANDA",
"middle_name": "CELESTE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-08-27",
"last_updated": "2008-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "PA",
"license": "DS024105L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.