Jeremiah D Gordon, DMD, PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

16348 Issued in FL

Legal business name

JEREMIAH D GORDON, DMD, PA

Doing business as

Gordon Dental Associates

Practice address

53 Willow Dr
St Augustine, FL 32080-5936

Phone

(904) 471-5336

NPI assigned

Jan 22, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Jeremiah D Gordon, DMDNPI 1497870646

Title

Dentis/Owner

Phone

(904) 460-0999

Specialties & licenses 1

Addresses

Other names 1

• Gordon Dental Associates Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeremiah Daniel Gordon, DMD

  • Dentist
  • St Augustine, FL
  • NPI 1497870646
  NPD (past) Authorized official

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

{
    "created_epoch": "1232582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1232582400000",
    "number": "1376781864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 JENKINS ST",
            "address_2": "SUITE 105A",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865175",
            "telephone_number": "904-460-0999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53 WILLOW DR",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320805936",
            "telephone_number": "904-471-5336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEREMIAH D GORDON, DMD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-22",
        "last_updated": "2009-01-22",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "JEREMIAH",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DENTIS/OWNER",
        "authorized_official_telephone_number": "904-460-0999",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "16348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gordon Dental Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Matthew Joseph Jeffs, PT
• Barbara Jenkin, MA,CAP
• Allison Jenkins
• James Louis Jenkins, LMHC
• Katherine M Jennison, RD LDN
• Jeremy Caudill DO
• Audrey Lee Jernigan, LMT
• George Alton Jernigan III
• Felicia Ann Jerome, D.O.
• Nathan Jimmerson, PTA

• General Practice Dentistry in St Augustine, FL
• Providers in St Augustine, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2009; 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.