Active NPI
Jessica Gong
- Dentist
- Boulder, CO
National Provider Identifier
1285257279
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DEN.00204879
- Practice address
- 4410 Arapahoe Ave Ste 230
Boulder, CO 80303-1198 - Phone
- (303) 442-4555
- NPI assigned
- May 25, 2020
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DEN.00204879 | CO | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
4410 Arapahoe Ave Ste 230
Boulder, CO 80303-1198
Mailing address
536 W 174TH Ave
Broomfield, CO 80023-5206
Phone (770) 596-6827
Other practice location 1
1775 Grand Concourse Fl 6
Bronx, NY 10453-8202
Phone (718) 901-8410
Other practice location 2
3960 River Point Pkwy Unit A
Sheridan, CO 80110-3315
Phone (303) 781-2340
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 |
|---|---|---|---|
| DEN.00204879 | CO | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| River Point Dental Group, LLP | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Sheridan, CO
- NPI 1720242902
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1590364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753228800000",
"number": "1285257279",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "536 W 174TH AVE",
"city": "BROOMFIELD",
"state": "CO",
"postal_code": "800235206",
"telephone_number": "770-596-6827"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4410 ARAPAHOE AVE STE 230",
"city": "BOULDER",
"state": "CO",
"postal_code": "803031198",
"telephone_number": "303-442-4555"
}
],
"practiceLocations": [
{
"address_1": "1775 Grand Concourse Fl 6",
"address_purpose": "LOCATION",
"city": "Bronx",
"state": "NY",
"postal_code": "104538202",
"country_code": "US",
"telephone_number": "718-901-8410",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3960 River Point Pkwy Unit A",
"address_purpose": "LOCATION",
"city": "Sheridan",
"state": "CO",
"postal_code": "801103315",
"country_code": "US",
"telephone_number": "303-781-2340",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GONG",
"first_name": "JESSICA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-05-25",
"last_updated": "2025-07-23",
"certification_date": "2025-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CO",
"license": "DEN.00204879",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 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.