Jeremiah Daniel Gordon, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DN16348 Issued in FL

Practice address

135 Jenkins St
Suite 105a
St Augustine, FL 32086-5175

Phone

(904) 460-0999

Fax

(904) 460-0999

NPI assigned

Mar 20, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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 and National Provider Directory roles.

• Jeremiah D Gordon, DMD, PA

  • General Practice Dentistry
  • St Augustine, FL
  • NPI 1376781864
  NPD (past) Authorized official

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1234310400000",
    "number": "1497870646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53 WILLOW DR",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320805936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "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",
            "fax_number": "904-460-0999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "JEREMIAH",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-20",
        "last_updated": "2009-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN16348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Isaac Gooding, M.D.
• Leah Goodman, LCSW, ACHP-SW
• Melanie Marie Goodwin, APRN
• Chovine Gardner Gordon, PT
• Diandra Kareen Gordon, DPM
• Tyrone M Gordon, RCSWI
• Nicole C Gortaire, DPM
• Jaimie Gosiker, BCBA
• Cody Scott Goslinga, D.M.D.
• Pierre Jean Gosselin, DMD

• Dentist in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 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.