Healthcare Provider Details

I. General information

NPI: 1750212106
Provider Name (Legal Business Name): SYDNEY GORDON DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 EASTGATE NORTH DR
CINCINNATI OH
45245-2050
US

IV. Provider business mailing address

119 W 4TH ST
SILVER GROVE KY
41085-5015
US

V. Phone/Fax

Practice location:
  • Phone: 513-978-5859
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.028465
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: