Provider Demographics
NPI:1366646622
Name:LAWRENCE J. LEVENS, DDS, MS, P.C.
Entity Type:Organization
Organization Name:LAWRENCE J. LEVENS, DDS, MS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:LEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, PC
Authorized Official - Phone:314-872-3218
Mailing Address - Street 1:2821 N BALLAS RD
Mailing Address - Street 2:SUITE 155
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2321
Mailing Address - Country:US
Mailing Address - Phone:314-872-3218
Mailing Address - Fax:314-872-3219
Practice Address - Street 1:2821 N BALLAS RD
Practice Address - Street 2:SUITE 155
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2321
Practice Address - Country:US
Practice Address - Phone:314-872-3218
Practice Address - Fax:314-872-3219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0145621223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO014562OtherSTATE LICENSE NUMBER