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General NPI Number Information
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NPI Number | 1497043616
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Entity Type | Individual
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Provider Name | PAUL M LEVASSEUR L.D.
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Gender | Male
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Dates
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Enumeration Date | 07/21/2011
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Last Update Date | 07/21/2011
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Provider Practice Location Address
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Address Line | 178 CAPE RD
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City | STANDISH
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State | ME
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Zip | 04084-6147
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Country | US
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Telephone | 207-642-2310
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Fax | 207-642-6815
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Provider Business Mailing Address
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Address Line | PO BOX 58 7 GRETCHEN LANE
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City | STANDISH
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State | ME
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Zip | 04084-0058
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Country | US
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Telephone | 207-642-2310
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Fax | 207-642-6815
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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 | 122400000X
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Taxonomy Name | Denturist
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License Number | 5010
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License Number State | ME
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