Gordon W Womack DDS Inc

Primary specialty

DentistTaxonomy code 122300000X

License

17287 Issued in OH

Legal business name

GORDON W WOMACK DDS INC

Doing business as

Beavercreek Pediatric Dentistry

Practice address

3300 Kemp Road
Beavercreek, OH 45431

Phone

(937) 426-2653

Fax

(937) 426-1124

NPI assigned

Jan 18, 2007

Last updated

Jul 22, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Gordon W Wommack, DDS

Title

Owner

Phone

(937) 426-2653

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Beavercreek Pediatric Dentistry Doing business as

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216684800000",
    "number": "1245382068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 KEMP ROAD",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "45431",
            "telephone_number": "937-426-2653",
            "fax_number": "937-426-1124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 KEMP ROAD",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "45431",
            "telephone_number": "937-426-2653",
            "fax_number": "937-426-1124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GORDON W WOMACK DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2008-07-22",
        "status": "A",
        "authorized_official_last_name": "WOMMACK",
        "authorized_official_first_name": "GORDON",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "937-426-2653",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "17287",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0617587",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beavercreek Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dentist in Beavercreek, OH
• Providers in Beavercreek, OH by specialty
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 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.

Verify at the official NPI Registry.