Provider Demographics
NPI:1073619755
Name:LEVIN, MARTIN ALBERT (DDS)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:ALBERT
Last Name:LEVIN
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 1:3704 NORTH CHARLES STREET
Mailing Address - Street 2:APT 304 ST JAMES CONDOMINIUMS
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2305
Mailing Address - Country:US
Mailing Address - Phone:410-243-2111
Mailing Address - Fax:443-836-0529
Practice Address - Street 1:1 VILLAGE SQUARE
Practice Address - Street 2:SUITE 130 CROSS KEYS
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-1698
Practice Address - Country:US
Practice Address - Phone:410-433-1977
Practice Address - Fax:410-433-6395
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD35231223P0300X
PADS0203264R1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics