Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 013071 | MO |
NPI | 1053438655 |
---|---|
Provider Name | Dr. David Michael Lebsack |
First Address | Saint Joseph, MO 64506-3074 |
Second Address | Saint Joseph, MO 64506-3074 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 08/07/2007 |