Gerald Ellis Anderson, D.M.D.
Individual provider Active NPI Dentist · Keizer, OR
NPI 1619975281 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1619975281
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D4704 (OR)
- Practice address
- 3975 River Rd N
Suite #5
Keizer, OR 97303-4811 - Phone
- (503) 393-9106
- Fax
- (503) 393-3053
- NPI assigned
- Jul 8, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|
| D4704 | OR | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lebaron Dentistry, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D4704 | OR | Yes |
Addresses
Primary practice location
3975 River Rd N
Suite #5
Keizer, OR 97303-4811
Mailing address
3975 River Rd N
Suite #5
Keizer, OR 97303-4811
Phone (503) 393-9106
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D4704 | Other | OR | OREGON DENTAL LICENSE # |
| 0250011-8 | Other | OR | OREGON BUSINESS ID # |
| 00454-9 | Medicaid | OR |
Other providers in Keizer, OR
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.