Individual
DR. JERRY WAYNE LEONARD, JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
5329 NE M L KING BLVD, PORTLAND, OR 97211-3237
(503) 988-3664
Mailing address
25796 SW CANYON CREEK RD, APT D304, WILSONVILLE, OR 97070-9659
(503) 682-5612
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D7672
OR
Other
Enumeration date
11/30/2006
Last updated
07/08/2007
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