Provider Demographics
NPI:1104860022
Name:LEFEBVRE, MICHAEL LUCIEN (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LUCIEN
Last Name:LEFEBVRE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64580 VAN DYKE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48095
Mailing Address - Country:US
Mailing Address - Phone:586-752-3589
Mailing Address - Fax:586-752-0198
Practice Address - Street 1:64580 VAN DYKE
Practice Address - Street 2:SUITE B
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48095
Practice Address - Country:US
Practice Address - Phone:586-752-3589
Practice Address - Fax:586-752-0198
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIML009949122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID808133OtherBLUE CROSS BLUE SHIELD