Jennifer L. Gordon, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

41608 Issued in CA

Practice address

1181 Central Blvd Ste E
Brentwood, CA 94513-2252

Phone

(925) 634-6105

Fax

(925) 634-7372

NPI assigned

Sep 2, 2006

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1157155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1699877464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1181 CENTRAL BLVD STE E",
            "city": "BRENTWOOD",
            "state": "CA",
            "postal_code": "945132252",
            "telephone_number": "925-634-6105",
            "fax_number": "925-634-7372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1181 CENTRAL BLVD STE E",
            "city": "BRENTWOOD",
            "state": "CA",
            "postal_code": "945132252",
            "telephone_number": "925-634-6105",
            "fax_number": "925-634-7372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "JENNIFER",
        "middle_name": "L.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "41608",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Brentwood, CA
• Providers in Brentwood, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.