Jodie Lydell Gordon, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

014930 Issued in MO

Practice address

1525 N New St
Kirksville, MO 63501-2472

Phone

(660) 665-7908

Fax

(660) 665-9399

NPI assigned

Aug 22, 2006

Sex

Male

Sole proprietor

Yes

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

Interoperability endpoints

• Direct secure messaging: jodie.gordon.p1@direct.pfh.nextgenshare.com

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687996800000",
    "number": "1659487601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 N NEW ST",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635012472",
            "telephone_number": "660-665-7908",
            "fax_number": "660-665-9399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 N NEW ST",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635012472",
            "telephone_number": "660-665-7908",
            "fax_number": "660-665-9399"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "141 Communication Dr",
            "address_purpose": "LOCATION",
            "city": "Hannibal",
            "state": "MO",
            "postal_code": "634013670",
            "country_code": "US",
            "telephone_number": "573-603-1460",
            "fax_number": "573-603-1462",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDON",
        "first_name": "JODIE",
        "middle_name": "LYDELL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "014930",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katelyn Elizabeth Glaspie, M.A., CCC-SLP
• Alyssa Golden
• Brent Gonda, DO
• Richard L Gooch, DDS
• Susanna Goodell-Fields
• Tara Gordon, PLPC
• Kajal Govin
• John Warren Goza
• Sue Granger, LCSW
• Kerena Areli Gray, DMD

• General Practice Dentistry in Kirksville, MO
• Providers in Kirksville, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2023; 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.