# DR. JERRY LEE LEONARD

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1104910694
- **Gender:** Man
- **Credential:** D.D.S.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 17407 | MD | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 5488 | OK | — |

## Other

- **Enumeration date:** 10/02/2006
- **Last updated:** 10/22/2021