Provider Demographics
NPI:1740404466
Name:LEVERETT, RICHARD NEVILLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:NEVILLE
Last Name:LEVERETT
Suffix:
Gender:M
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:PO BOX 412
Mailing Address - Street 2:
Mailing Address - City:ELBERTA
Mailing Address - State:AL
Mailing Address - Zip Code:36530-0412
Mailing Address - Country:US
Mailing Address - Phone:251-986-3500
Mailing Address - Fax:
Practice Address - Street 1:25088 EAST STATE STREET
Practice Address - Street 2:
Practice Address - City:ELBERTA
Practice Address - State:AL
Practice Address - Zip Code:36530-0412
Practice Address - Country:US
Practice Address - Phone:251-986-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4526122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist