Provider Demographics
NPI:1477769537
Name:DONLEVY, JEFFREY LEWIS (DDS,MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LEWIS
Last Name:DONLEVY
Suffix:
Gender:M
Credentials:DDS,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1072 AVIATION BLVD
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254
Mailing Address - Country:US
Mailing Address - Phone:310-318-3333
Mailing Address - Fax:310-798-2566
Practice Address - Street 1:1072 AVIATION BLVD
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254
Practice Address - Country:US
Practice Address - Phone:310-318-3333
Practice Address - Fax:310-798-2566
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA381811223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery