Healthcare Provider Details

I. General information

NPI: 1366646622
Provider Name (Legal Business Name): LAWRENCE J. LEVENS, DDS, MS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 N BALLAS RD SUITE 155
SAINT LOUIS MO
63131-2321
US

IV. Provider business mailing address

2821 N BALLAS RD SUITE 155
SAINT LOUIS MO
63131-2321
US

V. Phone/Fax

Practice location:
  • Phone: 314-872-3218
  • Fax: 314-872-3219
Mailing address:
  • Phone: 314-872-3218
  • Fax: 314-872-3219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number014562
License Number StateMO

VIII. Authorized Official

Name: DR. LAWRENCE JAY LEVENS
Title or Position: ORTHODONTIST
Credential: DDS, MS, P.C.
Phone: 314-872-3218