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General NPI Number Information
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NPI Number | 1144225418
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Entity Type | Individual
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Provider Name | RICHARD LAURENCE LEZELL D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 08/12/2013
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Provider Practice Location Address
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Address Line | 400 S NELSON ST
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City | POTTERVILLE
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State | MI
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Zip | 48876-9611
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Country | US
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Telephone | 517-645-9980
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Fax | 517-965-9980
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Provider Business Mailing Address
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Address Line | 3300 PARKLAND DR
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-1828
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Country | US
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Telephone | 248-851-7921
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Fax | 248-851-7921
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10341
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License Number State | MI
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