Provider Demographics
NPI:1366609372
Name:LEVASSEUR, PATRICK LEO (DDS)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:LEO
Last Name:LEVASSEUR
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 1:11000 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-2153
Mailing Address - Country:US
Mailing Address - Phone:248-698-2220
Mailing Address - Fax:248-698-0360
Practice Address - Street 1:11000 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48386-2153
Practice Address - Country:US
Practice Address - Phone:248-698-2220
Practice Address - Fax:248-698-0360
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI15414122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist