Individual
DR. LAWRENCE JAY LEVENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MS, PC
Contact information
Practice address
2821 N BALLAS RD, SUITE 155, SAINT LOUIS, MO 63131-2321
(314) 872-3218
(314) 872-3219
Mailing address
2821 N BALLAS RD, SUITE 155, SAINT LOUIS, MO 63131-2321
(314) 872-3218
(314) 872-3219
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
014562
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014562
STATE LICENSE NUMBER
MO
01
—
1366646622
NPI TYPE 2
MO
Enumeration date
02/07/2007
Last updated
07/08/2007
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