Provider Demographics
NPI:1649736430
Name:LESAVOY, BRET
Entity Type:Individual
Prefix:
First Name:BRET
Middle Name:
Last Name:LESAVOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3581 STURBRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-1776
Mailing Address - Country:US
Mailing Address - Phone:484-695-9512
Mailing Address - Fax:
Practice Address - Street 1:1352 SOUTH ST # C4
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-1858
Practice Address - Country:US
Practice Address - Phone:267-909-9551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-16
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0426101223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry