Provider Demographics
NPI:1881672053
Name:LEVESQUE, ROBERT P (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:LEVESQUE
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 1:80 DYER ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-2627
Mailing Address - Country:US
Mailing Address - Phone:508-672-5456
Mailing Address - Fax:508-672-8987
Practice Address - Street 1:80 DYER ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-2627
Practice Address - Country:US
Practice Address - Phone:508-672-5456
Practice Address - Fax:508-672-8987
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17160122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4001025OtherUNITED HEALTH
MAX06339OtherBCBS
RI86929OtherBCBS