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General NPI Number Information
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NPI Number | 1295620151
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Entity Type | Individual
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Provider Name | TARA JEAN LEVASSEUR
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Gender | Female
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 400 MASSASOIT AVE STE 300
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City | EAST PROVIDENCE
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State | RI
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Zip | 02914-2012
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Country | US
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Telephone | 401-490-7610
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Fax |
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Provider Business Mailing Address
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Address Line | 12 PRUDENCE CT
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City | WARWICK
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State | RI
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Zip | 02888-5731
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Country | US
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Telephone | 401-572-4016
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Fax |
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | PDH00051
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH02139
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License Number State | RI
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