Individual
DR. JERRY WAYNE LEONARD SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.MD.
Contact information
Practice address
2614 NE 22ND AVE, PORTLAND, OR 97212-4816
(503) 284-8114
Mailing address
2614 NE 22ND AVE, PORTLAND, OR 97212-4816
(503) 284-8114
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
OR5193
OR
Other
Enumeration date
08/19/2006
Last updated
02/22/2023
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