Brock Van Gordon, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D7947 Issued in OR

Practice address

6485 SW Borland Rd Ste G
Tualatin, OR 97062-9762

Phone

(503) 878-4163

Fax

(833) 438-7620

NPI assigned

Jan 16, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Dec 1, 2015 through Dec 1, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: brock.vangordon.1@32829.direct.athenahealth.com

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.

• Jab Dental LLC

  • Dentist
  • Wilsonville, OR
  • NPI 1164384442
  NPD (past)

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752451200000",
    "number": "1962554584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6485 SW BORLAND RD STE G",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970629762",
            "telephone_number": "503-730-4924",
            "fax_number": "833-438-7620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6485 SW BORLAND RD STE G",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970629762",
            "telephone_number": "503-878-4163",
            "fax_number": "833-438-7620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN GORDON",
        "first_name": "BROCK",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2025-07-14",
        "certification_date": "2025-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D7947",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D7947",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• TZ Medical Monitoring Solutions LLC
• Makoto Uchiyama, D.O.
• Dana Jones Ulrich, CNM
• United Seating and Mobility LLC
• Audrey C Unrau, MD
• Michael R Vanallen, M D P C
• Erik James Vankleek, MD
• Melissa Vansant, LPC
• Eric Hoan Vaulte
• Monique Vega

• General Practice Dentistry in Tualatin, OR
• Providers in Tualatin, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2025; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.