Provider Demographics
NPI:1275620114
Name:LEVICK, ALAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:LEVICK
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 1:150 COUNTRYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTRE
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2941
Mailing Address - Country:US
Mailing Address - Phone:617-965-2754
Mailing Address - Fax:617-244-9783
Practice Address - Street 1:214 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:02176-2997
Practice Address - Country:US
Practice Address - Phone:508-655-6262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA104411223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics