Provider Demographics
NPI:1477554483
Name:GERKEN, LEONARD BRYAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:BRYAN
Last Name:GERKEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10509N ORACLE RD 141
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-9381
Mailing Address - Country:US
Mailing Address - Phone:520-498-0500
Mailing Address - Fax:520-498-0504
Practice Address - Street 1:10509 N ORACLE RD
Practice Address - Street 2:SUITE 141
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-9375
Practice Address - Country:US
Practice Address - Phone:520-498-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD 68291223G0001X
AZD0083611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice