Provider Demographics
NPI:1306027685
Name:LEVENSON, JOSHUA BARUCH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:BARUCH
Last Name:LEVENSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 TOWN CENTER AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6914
Mailing Address - Country:US
Mailing Address - Phone:678-835-0793
Mailing Address - Fax:
Practice Address - Street 1:350 TOWN CENTER AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6914
Practice Address - Country:US
Practice Address - Phone:678-835-0793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013596122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist