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  5. Gordon Orthodontics, Inc

Gordon Orthodontics, Inc

Company Details

Name: Gordon Orthodontics, Inc
Jurisdiction: Rhode Island
Entity type: Professional Service Corporation
Status: Activ
Date of Organization in Rhode Island: 01 Feb 2010 (15 years ago)
Identification Number: 000526596
ZIP code: 02816
County: Kent County
Principal Address: 840 TIOGUE AVENUE, COVENTRY, RI, 02816, USA
Purpose: ORTHODONTIC PRACTICE
NAICS: 621210 - Offices of Dentists
Historical names: Ocean State Orthodontics, Inc.

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1285966481 2010-02-12 2011-01-31 840 TIOGUE AVE, COVENTRY, RI, 028165914, US 1171 MAIN STREET, HOPE VALLEY, RI, 02832, US

Contacts
Phone +1 401-828-1171
Fax 4018284704

Authorized person
Name DR. WILLIAM MICHAEL GORDON
Role ORTHODONTIST
Phone 4018281171

Taxonomy
Taxonomy Code 1223X0400X - Orthodontics and Dentofacial Orthopedic Dentist
Is Primary Yes

Other Provider Identifiers
Issuer UNITED CONCORDIA
Number 842039
State RI
Issuer MEDICAID
Number WG00555
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
WILLIAM M. GORDON, D.M.D. PENSION PLAN 2019 050468671 2020-10-13 GORDON ORTHODONTICS, INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621210
Sponsor’s telephone number 4018281171
Plan sponsor’s address 840 TIOGUE AVENUE, COVENTRY, RI, 02816

Signature of
Role Plan administrator
Date 2020-10-13
Name of individual signing WILLIAM GORDON
Valid signature Filed with authorized/valid electronic signature
WILLIAM M. GORDON, D.M.D. PENSION PLAN 2018 050468671 2019-08-08 GORDON ORTHODONTICS, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621210
Sponsor’s telephone number 4018281171
Plan sponsor’s address 840 TIOGUE AVENUE, COVENTRY, RI, 02816

Signature of
Role Plan administrator
Date 2019-08-08
Name of individual signing WILLIAM GORDON
Valid signature Filed with authorized/valid electronic signature
WILLIAM M. GORDON, D.M.D. PENSION PLAN 2017 050468671 2018-07-22 GORDON ORTHODONTICS, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621210
Sponsor’s telephone number 4018281171
Plan sponsor’s address 840 TIOGUE AVENUE, COVENTRY, RI, 02816

Signature of
Role Plan administrator
Date 2018-07-22
Name of individual signing WILLIAM GORDON
Valid signature Filed with authorized/valid electronic signature
WILLIAM M. GORDON, D.M.D. PENSION PLAN 2016 050468671 2017-10-04 GORDON ORTHODONTICS, INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621210
Sponsor’s telephone number 4018281171
Plan sponsor’s address 840 TIOGUE AVENUE, COVENTRY, RI, 02816

Signature of
Role Plan administrator
Date 2017-10-04
Name of individual signing WILLIAM GORDON
Valid signature Filed with authorized/valid electronic signature
WILLIAM M. GORDON, D.M.D. PENSION PLAN 2015 050468671 2016-07-27 GORDON ORTHODONTICS, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621210
Sponsor’s telephone number 4018281171
Plan sponsor’s address 840 TIOGUE AVENUE, COVENTRY, RI, 02816

Signature of
Role Plan administrator
Date 2016-07-27
Name of individual signing WILLIAM GORDON
Valid signature Filed with authorized/valid electronic signature
WILLIAM M. GORDON, D.M.D. PENSION PLAN 2014 050468671 2015-07-30 GORDON ORTHODONTICS, INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621210
Sponsor’s telephone number 4018281171
Plan sponsor’s address 840 TIOGUE AVENUE, COVENTRY, RI, 02816

Signature of
Role Plan administrator
Date 2015-07-30
Name of individual signing WILLIAM GORDON
Valid signature Filed with authorized/valid electronic signature
WILLIAM M. GORDON, D.M.D. PENSION PLAN 2013 050468671 2014-04-28 GORDON ORTHODONTICS, INC. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621210
Sponsor’s telephone number 4018281171
Plan sponsor’s address 840 TIOGUE AVENUE, COVENTRY, RI, 02816

Signature of
Role Plan administrator
Date 2014-04-28
Name of individual signing WILLIAM GORDON
Valid signature Filed with authorized/valid electronic signature
WILLIAM M. GORDON, D.M.D. PENSION PLAN 2012 050468671 2013-06-06 GORDON ORTHODONTICS, INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621210
Sponsor’s telephone number 4018281171
Plan sponsor’s address 840 TIOGUE AVENUE, COVENTRY, RI, 02816

Signature of
Role Plan administrator
Date 2013-06-06
Name of individual signing WILLIAM GORDON
Valid signature Filed with authorized/valid electronic signature
WILLIAM M. GORDON, D.M.D. PENSION PLAN 2011 050468671 2012-09-12 GORDON ORTHODONTICS, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621210
Sponsor’s telephone number 4018281171
Plan sponsor’s address 840 TIOGUE AVENUE, COVENTRY, RI, 02816

Plan administrator’s name and address
Administrator’s EIN 050468671
Plan administrator’s name GORDON ORTHODONTICS, INC.
Plan administrator’s address 840 TIOGUE AVENUE, COVENTRY, RI, 02816
Administrator’s telephone number 4018281171

Signature of
Role Plan administrator
Date 2012-09-12
Name of individual signing WILLIAM GORDON
Valid signature Filed with authorized/valid electronic signature
WILLIAM M. GORDON, D.M.D. PENSION PLAN 2010 050468671 2011-09-07 GORDON ORTHODONTICS, INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621210
Sponsor’s telephone number 4018281171
Plan sponsor’s address 840 TIOGUE AVENUE, COVENTRY, RI, 02816

Plan administrator’s name and address
Administrator’s EIN 050468671
Plan administrator’s name GORDON ORTHODONTICS
Plan administrator’s address 840 TIOGUE AVENUE, COVENTRY, RI, 02816
Administrator’s telephone number 4018281171

Signature of
Role Plan administrator
Date 2011-09-07
Name of individual signing WILLIAM GORDON
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
MARK G. SYLVIA Agent 56 EXCHANGE TERRACE, PROVIDENCE, RI, 02903, USA

PRESIDENT

Name Role Address
WILLIAM M GORDON PRESIDENT 840 TIOGUE AVENUE COVENTRY, RI 02816 USA

Events

Type Date Old Value New Value
Name Change 2010-12-14 Ocean State Orthodontics, Inc. Gordon Orthodontics, Inc

Filings

Number Name File Date
202450261400 Annual Report 2024-04-05
202325866970 Statement of Change of Registered/Resident Agent 2023-01-09
202225526820 Annual Report 2022-12-28
202225526910 Annual Report 2022-12-28
202225527070 Reinstatement 2022-12-28
202223914980 Revocation Certificate For Failure to File the Annual Report for the Year 2022-10-12
202220118020 Revocation Notice For Failure to File An Annual Report 2022-06-27
202195128790 Annual Report 2021-03-30
202035880020 Annual Report 2020-03-04
201986349570 Annual Report 2019-02-11

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MARK G. SYLVIA

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Related by address

840 TIOGUE AVENUE, COVENTRY, RI, 02816, USA

Coventry Cares, Inc. GBJ Holdings, LLC GRI LENDING LLC

Date of last update: 14 Oct 2024

Sources: Rhode Island Department of State

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