Provider Demographics
NPI:1144225418
Name:LEZELL, RICHARD LAURENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LAURENCE
Last Name:LEZELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3300 PARKLAND DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1828
Mailing Address - Country:US
Mailing Address - Phone:248-851-7921
Mailing Address - Fax:248-851-7921
Practice Address - Street 1:400 S NELSON ST
Practice Address - Street 2:
Practice Address - City:POTTERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48876-9611
Practice Address - Country:US
Practice Address - Phone:517-645-9980
Practice Address - Fax:517-965-9980
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI103411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice