Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 5010 | ME |
NPI | 1497043616 |
---|---|
Provider Name | Mr. Paul M Levasseur |
First Address | Standish, ME 04084-0058 |
Second Address | Standish, ME 04084-6147 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2011 |
Last Update Date | 21/07/2011 |