Leif Roger Gerritzen, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE60773945 Issued in WA

Practice address

669 Woodland Square Loop SE
Lacey, WA 98503-1038

Phone

(360) 359-4860

NPI assigned

Sep 4, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: lgerritzen452704@direct.multicare.org

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

{
    "created_epoch": "1504483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1504483200000",
    "number": "1790203339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34703",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981241703",
            "telephone_number": "206-764-0502",
            "fax_number": "206-764-0516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "669 WOODLAND SQUARE LOOP SE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985031038",
            "telephone_number": "360-359-4860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GERRITZEN",
        "first_name": "LEIF",
        "middle_name": "ROGER",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-04",
        "last_updated": "2017-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60773945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Florence Genovia, OTR
• William Georgeson
• Jane M. Geraci, M.D., MPH
• Seth C Gerken
• Betty Alicia German
• Redonda Kaye Gibbons, CERTIFIED PEER C
• Emily Gibbs, LMT
• Maude Nobue Gibbs, M.D.
• Jerry R Giddings, D.D.S.
• Martha J Gilbert, LMP

• General Practice Dentistry in Lacey, WA
• Providers in Lacey, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.