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General NPI Number Information
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NPI Number | 1598863292
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Entity Type | Individual
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Provider Name | LEON KIRK GARDNER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3710 SW US VETERAN HOSPTIAL RD
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City | PORTLAND
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State | OR
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Zip | 97239
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Country | US
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Telephone | 503-220-8262
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Fax |
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Provider Business Mailing Address
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Address Line | 7435 SW 49TH CT
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City | PORTLAND
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State | OR
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Zip | 97219
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Country | US
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Telephone | 503-244-6491
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 4567
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License Number State | AL
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