Patricia Lynn Gordon-Willis, D.M.D

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

12416 Issued in NC

Practice address

2643 Randleman Rd
Greensboro, NC 27406-5153

Phone

(336) 544-2758

NPI assigned

Jul 13, 2007

Last updated

Nov 22, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1184284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637539200000",
    "number": "1578762076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 N EUGENE ST APT 311",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274013398",
            "telephone_number": "601-212-5917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2643 RANDLEMAN RD",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274065153",
            "telephone_number": "336-544-2758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON-WILLIS",
        "first_name": "PATRICIA",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-13",
        "last_updated": "2021-11-22",
        "certification_date": "2021-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN014937",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "DC",
            "license": "DEN1000945",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NC",
            "license": "12416",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emma Goodson
• Heather Goodson
• Denice Goodwill, PTA
• Joseph Donati Goodwin, DO
• Carolyn Doughty Gordan, PNP
• Christopher Alan Gordon, R.PH.
• Dystine Tychena Gordon
• Leteyona Gordon
• Stuart Irving Gordon, PHARMACIST
• Theresa M Gordon, CRNA

• Pediatric Dentistry in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Pediatric Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2021; 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.

Verify at the official NPI Registry.