Provider Demographics
NPI:1235749441
Name:LEVY, DAVID BENJAMIN
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BENJAMIN
Last Name:LEVY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 TAYLOR RD OFC BLDG173
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-5600
Mailing Address - Country:US
Mailing Address - Phone:301-295-2737
Mailing Address - Fax:
Practice Address - Street 1:4650 TAYLOR RD OFC BLDG173
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5600
Practice Address - Country:US
Practice Address - Phone:301-295-2737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD11281122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist