Randall R Gordon, DDS, MS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

40598 Issued in CA

Practice address

1420 S Mills Ave
Suite G
Lodi, CA 95242-4291

Phone

(209) 369-1484

Fax

(209) 366-0998

NPI assigned

Sep 20, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1851498877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 S MILLS AVE",
            "address_2": "SUITE G",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952424291",
            "telephone_number": "209-369-1484",
            "fax_number": "209-366-0998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 S MILLS AVE",
            "address_2": "SUITE G",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952424291",
            "telephone_number": "209-369-1484",
            "fax_number": "209-366-0998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "RANDALL",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "40598",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Ashley Gonzalez
• Evelyn Gonzalez
• Isabel Gonzalez
• Jannel Gonzalez
• Susana Gonzalez
• Neeka Gorgani, DDS
• James J Grady Jr., MD
• Abigail Breann Graves
• Catherine Ann Gravish, P.T.
• Rabeep Kaur Grewal, M.D.

• Periodontics in Lodi, CA
• Providers in Lodi, CA by specialty
• Periodontics 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.