=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760365738
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEBOUEF FAMILY DENTAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2025
-----------------------------------------------------
Last Update Date | 07/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 172 CHRISTY ST
-----------------------------------------------------
City | AMHERST
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54406-9389
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-824-3300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6
-----------------------------------------------------
City | AMHERST
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54406-0006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-824-3300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER DENTIST
-----------------------------------------------------
Name | DR. JAMES A LEBOUEF
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 715-824-3300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------