Active NPI
Jared William Gordon, DMD
- Dentist
- Catoosa, OK
National Provider Identifier
1902596570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 7746
- Practice address
- 2036 S Miller LN Ste B
Catoosa, OK 74015-1539 - Phone
- (918) 937-7660
- NPI assigned
- May 8, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 7746 | OK | Primary |
Addresses
Primary practice location
2036 S Miller LN Ste B
Catoosa, OK 74015-1539
Mailing address
910 E Gary PL
Broken Arrow, OK 74012-7784
Phone (801) 874-9593
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7746 | OK | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683504000000",
"number": "1902596570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "910 E GARY PL",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740127784",
"telephone_number": "801-874-9593"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2036 S MILLER LN STE B",
"city": "CATOOSA",
"state": "OK",
"postal_code": "740151539",
"telephone_number": "918-937-7660"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "JARED",
"middle_name": "WILLIAM",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-05-08",
"last_updated": "2023-05-08",
"certification_date": "2023-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OK",
"license": "7746",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Catoosa, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 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.