Provider Demographics
NPI:1982846283
Name:LEBOUEF, JAMES ALAN (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALAN
Last Name:LEBOUEF
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:N2665 COUNTY ROAD QQ
Mailing Address - Street 2:WISCONSIN VETERANS HOME/ DENTAL CLINIC
Mailing Address - City:KING
Mailing Address - State:WI
Mailing Address - Zip Code:54946-0600
Mailing Address - Country:US
Mailing Address - Phone:715-258-5586
Mailing Address - Fax:
Practice Address - Street 1:N2665 COUNTY ROAD QQ
Practice Address - Street 2:WISCONSIN VETERANS HOME/ DENTAL CLINIC
Practice Address - City:KING
Practice Address - State:WI
Practice Address - Zip Code:54946-0600
Practice Address - Country:US
Practice Address - Phone:715-258-5586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4910122300000X
CA60602122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist