Provider Demographics
NPI:1811706799
Name:GORDON, JILLIAN (RDH, NBC-HWC)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:GORDON
Suffix:
Gender:
Credentials:RDH, NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 17TH ST # 1624
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1508
Mailing Address - Country:US
Mailing Address - Phone:301-697-6686
Mailing Address - Fax:
Practice Address - Street 1:5923 PIERCE ST APT 301
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-5549
Practice Address - Country:US
Practice Address - Phone:301-697-6686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A-3460972171400000X
CODH.002026369124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No171400000XOther Service ProvidersHealth & Wellness Coach