Provider Demographics
NPI:1982992731
Name:LEVESQUE, KEITH MICHAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:MICHAEL
Last Name:LEVESQUE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03064-2561
Mailing Address - Country:US
Mailing Address - Phone:443-553-4910
Mailing Address - Fax:603-882-4215
Practice Address - Street 1:61 AMHERST ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03064-2561
Practice Address - Country:US
Practice Address - Phone:443-553-4910
Practice Address - Fax:603-882-4215
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03842122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist