MEDICARE: SYDNEY GORDON DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30.028465	OH

General Provider Information

NPI Number	:	1750212106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY GORDON DMD

Provider Business Mailing Address
First Line	:	119 W 4TH ST
Second Line	:
City	:	SILVER GROVE
State	:	KY
Zip	:	41085-5015
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	880 EASTGATE NORTH DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45245-2050
Country	:	US
Telephone Number	:	513-978-5859
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2026
Last Update Date	:	05/26/2026

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