Dr. Jeremiah Daniel Gordon, DMD
Dentist in St Augustine, FL. Individual provider (NPI-1).
NPI number1497870646
StatusActive
Last updated in NPPESFeb 11, 2009
Details
- NPI
- 1497870646
- Entity type
- Individual (NPI-1)
- Name
- Dr. Jeremiah Daniel Gordon
- Credential
- DMD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 20, 2007
- Last updated
- Feb 11, 2009
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | DN16348 | FL | Yes |
Practice location
135 Jenkins StSuite 105a
St Augustine, FL 32086-5175
Phone 904-460-0999 · Fax 904-460-0999
Mailing address
53 Willow DrSt Augustine, FL 32080-5936
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All 36 Dentist providers in St Augustine · All 2,630 providers in St Augustine
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