Healthcare Provider Details

I. General information

NPI: 1952438780
Provider Name (Legal Business Name): FARREL F LEVASSEUR PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 WASHINGTON AVE SUITE 204
BAY CITY MI
48708-5730
US

IV. Provider business mailing address

916 WASHINGTON AVE SUITE 204
BAY CITY MI
48708-5730
US

V. Phone/Fax

Practice location:
  • Phone: 989-893-3579
  • Fax:
Mailing address:
  • Phone: 989-893-3579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberFL007097
License Number StateMI

VIII. Authorized Official

Name: DR. FARREL FRANCIS LEVASSEUR
Title or Position: PRESIDENT
Credential:
Phone: 989-893-3579