MEDICARE: DR. JOHN ANDREW LEVERENZ DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2901020669	MI

General Provider Information

NPI Number	:	1366797821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ANDREW LEVERENZ DDS

Provider Business Mailing Address
First Line	:	24619 HARPER AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-1272
Country	:	US
Telephone Number	:	586-773-1010
Fax Number	:

Provider Business Practice Location Address
First Line	:	24619 HARPER AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-1272
Country	:	US
Telephone Number	:	586-773-1010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2012
Last Update Date	:	07/19/2012

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