Provider Demographics
NPI:1902070311
Name:JOHN R. LEVERENZ DDS PC
Entity Type:Organization
Organization Name:JOHN R. LEVERENZ DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:LEVERENZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-773-1010
Mailing Address - Street 1:24619 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1272
Mailing Address - Country:US
Mailing Address - Phone:586-773-1010
Mailing Address - Fax:586-773-6555
Practice Address - Street 1:24619 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1272
Practice Address - Country:US
Practice Address - Phone:586-773-1010
Practice Address - Fax:586-773-6555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13171261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental