Provider Demographics
NPI:1851142749
Name:MARK R. LEBEL JR., DMD, PA
Entity Type:Organization
Organization Name:MARK R. LEBEL JR., DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:LEBEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-773-3738
Mailing Address - Street 1:1330 CONGRESS ST STE 2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2144
Mailing Address - Country:US
Mailing Address - Phone:207-773-3738
Mailing Address - Fax:207-773-5872
Practice Address - Street 1:1330 CONGRESS ST STE 2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2144
Practice Address - Country:US
Practice Address - Phone:207-773-3738
Practice Address - Fax:207-773-5872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty