Provider Demographics
NPI:1235238254
Name:LEVIN, ANDREW BERNARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:BERNARD
Last Name:LEVIN
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 1:1628 E SOUTHERN AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5685
Mailing Address - Country:US
Mailing Address - Phone:480-831-3898
Mailing Address - Fax:
Practice Address - Street 1:1628 E SOUTHERN AVE STE 5
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5685
Practice Address - Country:US
Practice Address - Phone:480-831-3898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ64391223G0001X
GADN0141771223G0001X
AZD009207122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice