Provider Demographics
NPI:1497043616
Name:LEVASSEUR, PAUL M (LD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:M
Last Name:LEVASSEUR
Suffix:
Gender:M
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 58
Mailing Address - Street 2:7 GRETCHEN LANE
Mailing Address - City:STANDISH
Mailing Address - State:ME
Mailing Address - Zip Code:04084-0058
Mailing Address - Country:US
Mailing Address - Phone:207-642-2310
Mailing Address - Fax:207-642-6815
Practice Address - Street 1:178 CAPE RD
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:ME
Practice Address - Zip Code:04084-6147
Practice Address - Country:US
Practice Address - Phone:207-642-2310
Practice Address - Fax:207-642-6815
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME5010122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist