Michael Anthony Gordon, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12009120 Issued in IN

Practice address

829 Main St
Schererville, IN 46375-1100

Phone

(219) 322-1929

Fax

(219) 322-1039

NPI assigned

Aug 21, 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

Enrolled in IN

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

Practice roles

Locations

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.

• Michael a. Gordon, DDS, PC

  • General Practice Dentistry
  • Schererville, IN
  • NPI 1366558546
  NPD Authorized official

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607040000000",
    "number": "1851407027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "829 MAIN ST",
            "city": "SCHERERVILLE",
            "state": "IN",
            "postal_code": "463751100",
            "telephone_number": "219-322-1929",
            "fax_number": "219-322-1039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "829 MAIN ST",
            "city": "SCHERERVILLE",
            "state": "IN",
            "postal_code": "463751100",
            "telephone_number": "219-322-1929",
            "fax_number": "219-322-1039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "MICHAEL",
        "middle_name": "ANTHONY",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-21",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12009120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jillian Renee Gidcumb, PT, DPT
• Derek Goins
• Zachary Edward Golden, PHARMD
• Macey Gonzales
• Jorge A Gonzalez, M.D.
• Donna Jean Govert
• Kaitlyn Govert, PT, DPT
• Graham Psychological Consulting, Inc
• Patricia Anna Graham, PSYD., HSPP
• Grand Smiles, PC

• General Practice Dentistry in Schererville, IN
• Providers in Schererville, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2020; 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.