Individual provider Active NPI

Leonard Bryan Gerken, DMD

  • General Practice Dentistry
  • Oro Valley, AZ
National Provider Identifier
1477554483
Registry record updated Dec 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D008361 Issued in AZ
Practice address
10509 N Oracle Rd
Suite 141
Oro Valley, AZ 85737-9375
Phone
(520) 498-0500
NPI assigned
Aug 2, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D 6829 OR
General Practice Dentistry 1223G0001X D008361 AZ Primary

Addresses

Primary practice location

10509 N Oracle Rd
Suite 141
Oro Valley, AZ 85737-9375

Mailing address

10509N Oracle Rd 141
Oro Valley, AZ 85737-9381
Phone (520) 498-0500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151229001640 AZ Order and Referring Only - DentistPractitioner - Dentist 4082915558

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D 6829ORMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Schmidtke Dental Northwest PLC Past Accepting new patients
537 W Wetmore Dental Inc Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450396800000",
    "number": "1477554483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10509N ORACLE RD 141",
            "city": "ORO VALLEY",
            "state": "AZ",
            "postal_code": "857379381",
            "telephone_number": "520-498-0500",
            "fax_number": "520-498-0504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10509 N ORACLE RD",
            "address_2": "SUITE 141",
            "city": "ORO VALLEY",
            "state": "AZ",
            "postal_code": "857379375",
            "telephone_number": "520-498-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GERKEN",
        "first_name": "LEONARD",
        "middle_name": "BRYAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-02",
        "last_updated": "2015-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D 6829",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D008361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oro Valley, AZ

Sources for this page

Verify at the official NPI Registry.