Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 4 5224 | OK |
NPI | 1063585073 |
---|---|
Provider Name | Dr. Craig A Gerken |
First Address | Ardmore, OK 73401-2246 |
Second Address | Ardmore, OK 73401-2246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 08/07/2007 |