Provider Demographics
NPI:1811961253
Name:LECAVALIER, ROSS (DDS)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:
Last Name:LECAVALIER
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 1:3636 ROUNDTREE CT
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-1430
Mailing Address - Country:US
Mailing Address - Phone:303-288-3718
Mailing Address - Fax:
Practice Address - Street 1:1333 W 120TH AVE
Practice Address - Street 2:SUITE #307
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2708
Practice Address - Country:US
Practice Address - Phone:303-288-1904
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7519122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist