MEDICARE: LEONARD RAY, DDS/JERRY A. GILPIN, DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1407004187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEONARD RAY, DDS/JERRY A. GILPIN, DMD

Provider Business Mailing Address
First Line	:	776 S MAIN ST
Second Line	:
City	:	ASHLAND CITY
State	:	TN
Zip	:	37015-1405
Country	:	US
Telephone Number	:	615-792-4238
Fax Number	:	615-792-1895

Provider Business Practice Location Address
First Line	:	776 S MAIN ST
Second Line	:
City	:	ASHLAND CITY
State	:	TN
Zip	:	37015-1405
Country	:	US
Telephone Number	:	615-792-4238
Fax Number	:	615-792-1895

Authorized Official
Title or Position	:	OFFICE STAFF
Name	:	DAPHNE JOHNSON
Credential	:
Telephone Number	:	615-792-4238

Provider Enumeration Date	:	09/05/2008
Last Update Date	:	09/05/2008

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