Provider Demographics
NPI:1316430655
Name:LEBOEUF, ALYSSA NICOLE
Entity type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:NICOLE
Last Name:LEBOEUF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8730 FREMONT STREET
Mailing Address - Street 2:APT. 120
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68507
Mailing Address - Country:US
Mailing Address - Phone:620-704-3242
Mailing Address - Fax:
Practice Address - Street 1:1265 S COTNER BLVD STE 1
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4924
Practice Address - Country:US
Practice Address - Phone:402-904-6001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7465122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist