Active NPI
David Michael Gordon, D.D.S.
- Dentist
- Vallejo, CA
National Provider Identifier
1487757308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 31465
- Practice address
- 23 Rotary Way
Vallejo, CA 94591-8475 - Phone
- (707) 557-2200
- Fax
- (707) 642-7502
- NPI assigned
- Sep 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 31465 | CA | Primary |
Addresses
Primary practice location
23 Rotary Way
Vallejo, CA 94591-8475
Mailing address
823 Bantry Court
Benicia, CA 94510
Phone (707) 745-1344
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151217000847 | CA | Order and Referring Only - Oral Surgery | 2264733104 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1487757308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "823 BANTRY COURT",
"city": "BENICIA",
"state": "CA",
"postal_code": "94510",
"telephone_number": "707-745-1344",
"fax_number": "707-642-7502"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23 ROTARY WAY",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945918475",
"telephone_number": "707-557-2200",
"fax_number": "707-642-7502"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "DAVID",
"middle_name": "MICHAEL",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "31465",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vallejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.