Individual provider Active NPI

Gordon J Smith, DDS

  • General Practice Dentistry
  • Boynton Beach, FL
National Provider Identifier
1538250089
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
8620 Issued in FL
Practice address
1250 South Federal Hwy 101
Boynton Beach, FL 33435
Phone
(561) 732-9727
Fax
(561) 736-3644
NPI assigned
Sep 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 8620 FL Primary

Addresses

Primary practice location

1250 South Federal Hwy 101
Boynton Beach, FL 33435

Mailing address

1250 South Federal Hwy 101
Boynton Beach, FL 33435
Phone (561) 732-9727

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160517000655 FL Order and Referring Only - DentistPractitioner - Dentist 8022307933

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8620FLMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1538250089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 SOUTH FEDERAL HWY 101",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "33435",
            "telephone_number": "561-732-9727",
            "fax_number": "561-736-3644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 SOUTH FEDERAL HWY 101",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "33435",
            "telephone_number": "561-732-9727",
            "fax_number": "561-736-3644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "GORDON",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "8620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boynton Beach, FL

Sources for this page

Verify at the official NPI Registry.