Provider Demographics
NPI:1598343568
Name:LEVESQUE, MARISSA L (DMD)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:L
Last Name:LEVESQUE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04643-3043
Mailing Address - Country:US
Mailing Address - Phone:207-483-4502
Mailing Address - Fax:207-483-2750
Practice Address - Street 1:50 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRINGTON
Practice Address - State:ME
Practice Address - Zip Code:04643-3043
Practice Address - Country:US
Practice Address - Phone:207-483-4502
Practice Address - Fax:207-483-2750
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4952122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist