MEDICARE: BRET LESAVOY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	DS042610	PA

General Provider Information

NPI Number	:	1649736430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRET LESAVOY

Provider Business Mailing Address
First Line	:	3581 STURBRIDGE PL
Second Line	:
City	:	ALLENTOWN
State	:	PA
Zip	:	18104-1776
Country	:	US
Telephone Number	:	484-695-9512
Fax Number	:

Provider Business Practice Location Address
First Line	:	1352 SOUTH ST # C4
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-1858
Country	:	US
Telephone Number	:	267-909-9551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2019
Last Update Date	:	07/01/2021

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Directions to “ BRET LESAVOY ” Practice Location

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