Provider Demographics
NPI:1508175928
Name:LEFEVRE DENTISTRY, INC
Entity Type:Organization
Organization Name:LEFEVRE DENTISTRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DELAYNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LEFEVRE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-867-3335
Mailing Address - Street 1:5520 PEBBLE VILLAGE LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-7423
Mailing Address - Country:US
Mailing Address - Phone:317-867-3335
Mailing Address - Fax:317-867-3337
Practice Address - Street 1:5520 PEBBLE VILLAGE LN
Practice Address - Street 2:SUITE 200
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-7423
Practice Address - Country:US
Practice Address - Phone:317-867-3335
Practice Address - Fax:317-867-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10831261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200870170 AMedicaid