Provider Demographics
NPI:1205837853
Name:LEVINE, MARK ELLIOT (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ELLIOT
Last Name:LEVINE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8683 E LINCOLN AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-9812
Mailing Address - Country:US
Mailing Address - Phone:303-484-1246
Mailing Address - Fax:
Practice Address - Street 1:8683 E LINCOLN AVE STE 130
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-9812
Practice Address - Country:US
Practice Address - Phone:303-484-1246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.001041381223E0200X
CO1041381223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics