Provider Demographics
NPI:1477533248
Name:LEVERENZ, JOHN ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:LEVERENZ
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 1:24619 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1272
Mailing Address - Country:US
Mailing Address - Phone:586-773-1010
Mailing Address - Fax:586-773-6555
Practice Address - Street 1:24619 HARPER AVE
Practice Address - Street 2:
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1272
Practice Address - Country:US
Practice Address - Phone:586-773-1010
Practice Address - Fax:586-773-6555
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI131711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice