Christopher Michael Gordon

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN1859344 Issued in MA

Practice address

840 Tiogue Ave
Coventry, RI 02816-2900

Phone

(401) 828-1171

NPI assigned

Mar 27, 2020

Last updated

Jun 20, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ri Specialty Dental Services, LLC

  • Pediatric Dentistry
  • Coventry, RI
  • NPI 1336912112
  NPD (past)

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

{
    "created_epoch": "1585267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655683200000",
    "number": "1497383319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 PLEASANT ST",
            "city": "NORTH KINGSTOWN",
            "state": "RI",
            "postal_code": "028525047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 TIOGUE AVE",
            "city": "COVENTRY",
            "state": "RI",
            "postal_code": "028162900",
            "telephone_number": "401-828-1171"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2475 Broadway Bluffs Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "MO",
            "postal_code": "652018147",
            "country_code": "US",
            "telephone_number": "573-777-9282",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDON",
        "first_name": "CHRISTOPHER",
        "middle_name": "MICHAEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-27",
        "last_updated": "2022-06-20",
        "certification_date": "2022-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "RI",
            "license": "DEN03596",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MA",
            "license": "DN1859344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Gilmartin, RPH
• James E Ginda, MA, RRT, AE-C, FAARC
• Jeffrey Glidden
• Richard J Goccia, M.D.
• Gordon Orthodontics, Inc.
• William Michael Gordon, DMD
• Donna M Gormley
• GPS Physician Group of Rhode Island PC
• Erin Elizabeth Grady
• Jacqueline Greco

• Pediatric Dentistry in Coventry, RI
• Providers in Coventry, RI by specialty
• Pediatric Dentistry in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2022; 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.