Provider Demographics
NPI:1053438655
Name:LEBSACK, DAVID MICHAEL (DDS MS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:LEBSACK
Suffix:
Gender:M
Credentials:DDS MS
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Mailing Address - Street 1:3105 FREDERICK AVE STE A
Mailing Address - Street 2:SUITE #A
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3074
Mailing Address - Country:US
Mailing Address - Phone:816-279-2435
Mailing Address - Fax:816-279-7426
Practice Address - Street 1:3105 FREDERICK AVE STE A
Practice Address - Street 2:SUITE #A
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3074
Practice Address - Country:US
Practice Address - Phone:816-279-2435
Practice Address - Fax:816-279-7426
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO0130711223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics