Individual
DR. GERALD CLARK LEAKE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2828 INTERNATIONAL CIR, SUITE 100, COLORADO SPRINGS, CO 80910-3127
(719) 632-5700
Mailing address
3205 N ACADEMY BLVD, SUITE 130, COLORADO SPRINGS, CO 80917-5147
(719) 632-5700
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12008918A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
68121725
—
CO
Enumeration date
11/29/2005
Last updated
04/04/2017
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