Provider Demographics
NPI:1942232673
Name:LECOMTE, MICHELE MARIE (DDS, PC)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:MARIE
Last Name:LECOMTE
Suffix:
Gender:F
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:863 COUNTY ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02726-5033
Mailing Address - Country:US
Mailing Address - Phone:508-674-4556
Mailing Address - Fax:508-674-5360
Practice Address - Street 1:863 COUNTY ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02726-5033
Practice Address - Country:US
Practice Address - Phone:508-674-4556
Practice Address - Fax:508-674-5360
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA142951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX08388OtherBC/BS PRIOVIDER NUMBER
MA0001021OtherDELTA DENTAL OF MA PROVID