Phillip Brandon Gordon, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN016102 Issued in GA

Practice address

123 Hill Pond LN
Statesboro, GA 30458-0872

Phone

(912) 402-5437

NPI assigned

Feb 21, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Dogwood Pediatric Dentistry of Pooler, LLC

  • Pediatric Dentistry
  • Pooler, GA
  • NPI 1396474458
  NPD (past)
• Dogwood Pediatric Dentistry of Savannah

  • Pediatric Dentistry
  • Savannah, GA
  • NPI 1659819613
  NPD (past)
• Dogwood Pediatric Dentistry of Statesboro, LLC

  • Pediatric Dentistry
  • Statesboro, GA
  • NPI 1871145557
  NPD (past)

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

{
    "created_epoch": "1582243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722297600000",
    "number": "1942833595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2128 GARY ST",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309043573",
            "telephone_number": "478-501-3199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 HILL POND LN",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304580872",
            "telephone_number": "912-402-5437"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Blue Moon Xing Ste 105",
            "address_purpose": "LOCATION",
            "city": "Pooler",
            "state": "GA",
            "postal_code": "313229809",
            "country_code": "US",
            "telephone_number": "912-200-8841",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4849 Paulsen St Ste 101",
            "address_purpose": "LOCATION",
            "city": "Savannah",
            "state": "GA",
            "postal_code": "314054424",
            "country_code": "US",
            "telephone_number": "912-298-5437",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDON",
        "first_name": "PHILLIP",
        "middle_name": "BRANDON",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-02-21",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "GA",
            "license": "DN016102",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN016102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacey Glenn Girardeau, RPH
• Juliet S Givens, LPN
• Hailee Goare
• Anuj Goel, MD
• Laniea Golden, LPC
• Donald Graham, D.O.
• Shelby Jordan Palmerton Graham, MSN, APRN, WHNP-BC
• Jillian Zofia Grantham
• Sarah Grantham, PT
• Jennifer H Gray, NP

• Pediatric Dentistry in Statesboro, GA
• Providers in Statesboro, GA by specialty
• Pediatric Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2024; 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.