Provider Demographics
NPI:1003986977
Name:LEVEY, JONATHAN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:A
Last Name:LEVEY
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 1:7517 CAMERON RD STE 107
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-2055
Mailing Address - Country:US
Mailing Address - Phone:425-371-1222
Mailing Address - Fax:512-371-3914
Practice Address - Street 1:105 WILDWOOD DR STE 216
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-1352
Practice Address - Country:US
Practice Address - Phone:512-942-6729
Practice Address - Fax:512-942-6846
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000073941223G0001X
TX28811122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice