Provider Demographics
NPI:1457595266
Name:GERKEN ORTHODONTICS, LLC
Entity Type:Organization
Organization Name:GERKEN ORTHODONTICS, LLC
Other - Org Name:DR. CRAIG A GERKEN, D.D.S.
Other - Org Type:Other Name
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:GERKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:580-226-8868
Mailing Address - Street 1:1201 KIOWA ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-2260
Mailing Address - Country:US
Mailing Address - Phone:580-226-8868
Mailing Address - Fax:
Practice Address - Street 1:1201 KIOWA ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2260
Practice Address - Country:US
Practice Address - Phone:580-226-8868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK52241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty