Provider Demographics
NPI:1104984723
Name:LEFEVRE, JOHN WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:LEFEVRE
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:PO BOX 133
Mailing Address - Street 2:105 GLASGOW ST
Mailing Address - City:CLYDE
Mailing Address - State:NY
Mailing Address - Zip Code:14433-0133
Mailing Address - Country:US
Mailing Address - Phone:315-923-3231
Mailing Address - Fax:
Practice Address - Street 1:105 GLASGOW ST
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NY
Practice Address - Zip Code:14433-0133
Practice Address - Country:US
Practice Address - Phone:315-923-3231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023269122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY023269OtherLICENSE #
NY00447521Medicaid