Provider Demographics
NPI:1023001104
Name:LEVY, RICHARD B (DDS)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:B
Last Name:LEVY
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 1:4301 MILITARY RD NW
Mailing Address - Street 2:UNIT #603
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015
Mailing Address - Country:US
Mailing Address - Phone:860-280-7678
Mailing Address - Fax:
Practice Address - Street 1:4301 MILITARY RD NW
Practice Address - Street 2:UNIT #603
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015
Practice Address - Country:US
Practice Address - Phone:860-280-7678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4064122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist