Provider Demographics
NPI:1073620746
Name:LEVIN, MARK S (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:LEVIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1055 KEMPSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-5501
Mailing Address - Country:US
Mailing Address - Phone:757-474-1200
Mailing Address - Fax:757-474-9392
Practice Address - Street 1:1055 KEMPSVILLE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-5501
Practice Address - Country:US
Practice Address - Phone:757-474-1200
Practice Address - Fax:757-474-9392
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010057061223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA021357OtherUNITED CONCORDIA