Active NPI
Kobie Charles Gordon, DDS
- General Practice Dentistry
- Greenwood, IN
National Provider Identifier
1316582877
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DEN03465
- Practice address
- 1499 Windhorst Way Ste 100
Greenwood, IN 46143-8800 - Phone
- (703) 655-0464
- NPI assigned
- Nov 8, 2019
- Sex
- Male
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DEN03465 | RI | Primary |
Addresses
Primary practice location
1499 Windhorst Way Ste 100
Greenwood, IN 46143-8800
Mailing address
1499 Windhorst Way Ste 100
Greenwood, IN 46143-8800
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 |
|---|---|---|---|
| DEN03465 | RI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1573171200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782172800000",
"number": "1316582877",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1499 WINDHORST WAY STE 100",
"city": "GREENWOOD",
"state": "IN",
"postal_code": "461438800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1499 WINDHORST WAY STE 100",
"city": "GREENWOOD",
"state": "IN",
"postal_code": "461438800",
"telephone_number": "703-655-0464"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "KOBIE",
"middle_name": "CHARLES",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-11-08",
"last_updated": "2026-06-23",
"certification_date": "2026-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "RI",
"license": "DEN03465",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenwood, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.