Leo Dan Gordon, DDS
Individual provider Active NPI General Practice Dentistry · Weimar, TX
NPI 1073593497 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1073593497
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- TX15621 (TX)
- Practice address
- 503 E Main St
Weimar, TX 78962 - Phone
- (979) 725-8562
- Fax
- (979) 725-6822
- NPI assigned
- Jan 20, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TX15621 | TX | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | TX15621 | TX | Yes |
Addresses
Primary practice location
503 E Main St
Weimar, TX 78962
Mailing address
503 E Main St
Weimar, TX 78962
Phone (979) 725-8562
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D15621 | Other | BCBS | |
| 837109 | Other | UNITED CONCORDIA |
Other providers in Weimar, TX
- Delia Mercedes Duchicela
- Jorge A Duchicela
- Olga I Duchicela
- Wendy Lynn Florus
- Duwayne Gardner
- Robert R Graham
- Hatch
- Loueva Hatfield
- Judi Henneke
- Hernan Patino, MD, PA
All providers in Weimar, TX · General Practice Dentistry in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.