Jeffrey Glen Gordon, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019023383 Issued in IL

Practice address

8244 S Kedzie Ave
Chicago, IL 60652-3329

Phone

(773) 445-3337

Fax

(773) 445-3340

NPI assigned

Mar 26, 2008

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

State licenses

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.

• The Preventive Dentistry CNTR PC

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1447410139
  NPD Authorized official

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

{
    "created_epoch": "1206489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645142400000",
    "number": "1932371259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 29052",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606290052",
            "telephone_number": "773-445-3337",
            "fax_number": "773-445-3340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8244 S KEDZIE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606523329",
            "telephone_number": "773-445-3337",
            "fax_number": "773-445-3340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "JEFFREY",
        "middle_name": "GLEN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-03-26",
        "last_updated": "2022-02-18",
        "certification_date": "2022-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019023383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin B Gordon, M.S.W., L.C.S.W.
• Hilton Gordon, MD
• Howard Seth Gordon, MD
• Jamie Lynne Gordon, LAT, ATC
• Jason R Gordon, MD
• Jill Gordon, MSW, LCSW
• Jonathan Gordon, MD
• Julia Gordon, APRN-BC
• Justin R Gordon, OD
• Katherine Gordon, CRNA

• General Practice Dentistry in Chicago, IL
• Providers in Chicago, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2022; 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.