Provider Demographics
NPI:1093729071
Name:LEVY DENTAL GROUP, P.C.
Entity Type:Organization
Organization Name:LEVY DENTAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-865-2245
Mailing Address - Street 1:921 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3926
Mailing Address - Country:US
Mailing Address - Phone:203-865-2245
Mailing Address - Fax:203-787-1228
Practice Address - Street 1:921 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3926
Practice Address - Country:US
Practice Address - Phone:203-865-2245
Practice Address - Fax:203-787-1228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0050381223G0001X
CT0081481223G0001X
CT0081781223P0300X
CT0088801223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Not Answered1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty