Provider Demographics
NPI:1811083256
Name:LEFKOVE, MICHAEL D (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:LEFKOVE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 N COBB ST
Mailing Address - Street 2:STE 140
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-2390
Mailing Address - Country:US
Mailing Address - Phone:478-452-3768
Mailing Address - Fax:478-452-2704
Practice Address - Street 1:750 N COBB ST
Practice Address - Street 2:STE 140
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2390
Practice Address - Country:US
Practice Address - Phone:478-452-3768
Practice Address - Fax:478-452-2704
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA86851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1053558049OtherADDITIONAL NPI