Charles Ggordon DDS LLC

Primary specialty

DentistTaxonomy code 122300000X

License

7308 Issued in CO

Legal business name

CHARLES GGORDON DDS LLC

Practice address

1026 Eagleridge Blvd
Pueblo, CO 81008-2130

Phone

(719) 544-7672

NPI assigned

Jan 28, 2015

Last updated

Jan 28, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Charles Gordon, DDSNPI 1831164722

Title

Dentist

Phone

(719) 544-7672

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Charles G. Gordon, D.D.S.

  • General Practice Dentistry
  • Pueblo, CO
  • NPI 1831164722
  NPD (past) Authorized official

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

{
    "created_epoch": "1422403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422403200000",
    "number": "1528458510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1026 EAGLERIDGE BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082130",
            "telephone_number": "719-544-7672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1026 EAGLERIDGE BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082130",
            "telephone_number": "719-544-7672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES GGORDON DDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-28",
        "last_updated": "2015-01-28",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "719-544-7672",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "7308",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02073088",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Aaron Chapman, D.D.S.
• Amaya Lee Charboneau
• Joyce Kathy Charboneau, BS,CACII
• Charles E Schneider DPM PC
• Charles G Gordon DDS LLC
• Charles Wohlwend Ddspc (Eagleridge Dental)
• Gregory L Charleston, AGACNP-BC
• Jody Charter
• David Chartrand, BC-HIS
• Chase Integrated Care

• Dentist in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Dentist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2015; 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.