Provider Demographics
NPI:1215229703
Name:MARK LEVY DDS INC
Entity Type:Organization
Organization Name:MARK LEVY DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-476-6696
Mailing Address - Street 1:925 N HAMILTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-8708
Mailing Address - Country:US
Mailing Address - Phone:614-476-6696
Mailing Address - Fax:614-476-5366
Practice Address - Street 1:925 N HAMILTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-8708
Practice Address - Country:US
Practice Address - Phone:614-476-6696
Practice Address - Fax:614-476-5366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30016150261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6387970001Medicare NSC