Yuanbing Gong, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DEN.00206132 Issued in CO

Practice address

Fountain Modern Dentistry and Orthodontics
6940 Mesa Ridge Pkwy
Fountain, CO 80817

Phone

(434) 332-5919

NPI assigned

Sep 22, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

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.

• Patrick M Todd, DDS Inc

  • General Practice Dentistry
  • Rustburg, VA
  • NPI 1295073963
  NPD (past)

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

{
    "created_epoch": "1474502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735516800000",
    "number": "1609325497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1667 COCHRANE CIR BLDG 7495",
            "city": "FORT CARSON",
            "state": "CO",
            "postal_code": "809134603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "FOUNTAIN MODERN DENTISTRY AND ORTHODONTICS",
            "address_2": "6940 MESA RIDGE PKWY",
            "city": "FOUNTAIN",
            "state": "CO",
            "postal_code": "80817",
            "telephone_number": "434-332-5919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONG",
        "first_name": "YUANBING",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-09-22",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401415431",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401415431",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "DEN.00206132",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMONWEALTH OF VIRGINIA DEPT OF HEALTH PROFESSIONS",
            "identifier": "0401415431",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1609325497",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clarisa Ruby Gipson
• Moriah Kaye Giusti, RBT
• Marie Regina Glasgow, FNP-BC
• Gnomie'S Place PLLC
• Savanna Golson, PT
• Kevin Andrew Gonzalez, DPT
• Heather Gorman, COTA
• Susan Grant
• Mia Green
• Ground Up Recovery, LLC

• General Practice Dentistry in Fountain, CO
• Providers in Fountain, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2024; 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.