Provider Demographics
NPI:1306031794
Name:LEVENE HARVELL, LEZLI ANTONETTE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEZLI
Middle Name:ANTONETTE
Last Name:LEVENE HARVELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:24 COMMERCE ST
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-4060
Mailing Address - Country:US
Mailing Address - Phone:973-391-1000
Mailing Address - Fax:973-391-1005
Practice Address - Street 1:24 COMMERCE ST
Practice Address - Street 2:SUITE 1100
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-4060
Practice Address - Country:US
Practice Address - Phone:973-391-1000
Practice Address - Fax:973-391-1005
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0097181223G0001X
NY0533511223G0001X
NJ22DI023709001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0170356Medicaid