Provider Demographics
NPI:1821576513
Name:LEVESQUE, LENA MARIE (DMD)
Entity type:Individual
Prefix:
First Name:LENA
Middle Name:MARIE
Last Name:LEVESQUE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:778 SPRINGSBURY RD
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22611-1513
Mailing Address - Country:US
Mailing Address - Phone:703-342-9628
Mailing Address - Fax:
Practice Address - Street 1:1516 N SHENANDOAH AVE
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-3648
Practice Address - Country:US
Practice Address - Phone:540-636-2003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401416252122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist