Provider Demographics
NPI:1790858223
Name:LEDEN, GORDON FRANCIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:FRANCIS
Last Name:LEDEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:1104 COLLEGE ST
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565
Mailing Address - Country:US
Mailing Address - Phone:919-693-4090
Mailing Address - Fax:919-693-9255
Practice Address - Street 1:1104 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-0189
Practice Address - Country:US
Practice Address - Phone:919-693-4090
Practice Address - Fax:919-693-9255
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3845122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8995191Medicaid
NC8995191Medicaid