MEDICARE: DR. LEONARD BRYAN GERKEN 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	D 6829	OR
2	1223G0001X	General Practice Dentistry	D008361	AZ

General Provider Information

NPI Number	:	1477554483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONARD BRYAN GERKEN DMD

Provider Business Mailing Address
First Line	:	10509N ORACLE RD 141
Second Line	:
City	:	ORO VALLEY
State	:	AZ
Zip	:	85737-9381
Country	:	US
Telephone Number	:	520-498-0500
Fax Number	:	520-498-0504

Provider Business Practice Location Address
First Line	:	10509 N ORACLE RD
Second Line	:	SUITE 141
City	:	ORO VALLEY
State	:	AZ
Zip	:	85737-9375
Country	:	US
Telephone Number	:	520-498-0500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	12/18/2015

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