Healthcare Provider Details

I. General information

NPI: 1720977663
Provider Name (Legal Business Name): DAVID PERRAULT-LEVESQUE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 RUE LAURIER
MAGOG QUEBEC
J1X 2K3
CA

IV. Provider business mailing address

3299 BRIGHTON BLVD UNIT 465
DENVER CO
80216-3864
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00206240
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: