Provider Demographics
NPI:1316016090
Name:LEVY, DAVID P (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:LEVY
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 1:10735 S CICERO AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-5400
Mailing Address - Country:US
Mailing Address - Phone:708-422-2426
Mailing Address - Fax:708-422-2085
Practice Address - Street 1:10735 S CICERO AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-5400
Practice Address - Country:US
Practice Address - Phone:708-422-2426
Practice Address - Fax:708-422-2085
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A160201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice