Provider Demographics
NPI:1447269022
Name:LEBRON, MARIE L (DENTAL ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:L
Last Name:LEBRON
Suffix:
Gender:F
Credentials:DENTAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 SW 47TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-8054
Mailing Address - Country:US
Mailing Address - Phone:580-351-1111
Mailing Address - Fax:
Practice Address - Street 1:1315 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3605
Practice Address - Country:US
Practice Address - Phone:580-357-6981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant