Katherine Ann O'Gorman, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6544 Issued in NV

Practice address

735 Sparks Blvd
Sparks, NV 89434-7930

Phone

(775) 359-3934

Fax

(775) 359-4034

NPI assigned

Oct 14, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Katherine Ann Jacques Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jul 1, 2017 through Jul 1, 2027

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1413244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413244800000",
    "number": "1659775005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3545 LODESTAR LN",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895031224",
            "telephone_number": "775-233-2603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 SPARKS BLVD",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "894347930",
            "telephone_number": "775-359-3934",
            "fax_number": "775-359-4034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'GORMAN",
        "first_name": "KATHERINE",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-14",
        "last_updated": "2014-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NV",
            "license": "6544",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHERINE",
            "last_name": "JACQUES",
            "middle_name": "ANN",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• NV St DV MH/DS No NV Mr Svce
• NV St DV MH/DS Rural Regional Center
• NV St DV MH/DS Rural Regional Center
• Nholbie O'Campo
• Patrick O'Donnell, MD
• Julia O'Leary, APRN, FNP, PMHNP-BC
• Michael Lynn O'Leary, RPH
• Hannah O'Neill, PT
• Timothy J O'Shea
• Pamela Obah, PHARMD

• General Practice Dentistry in Sparks, NV
• Providers in Sparks, NV by specialty
• General Practice Dentistry in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2014; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.