Provider Demographics
NPI:1497933261
Name:LEVINE, NOLEN L (DDS)
Entity Type:Individual
Prefix:
First Name:NOLEN
Middle Name:L
Last Name:LEVINE
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 1:120 OAK BROOK CENTER MALL
Mailing Address - Street 2:528
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1806
Mailing Address - Country:US
Mailing Address - Phone:630-571-3430
Mailing Address - Fax:630-571-3567
Practice Address - Street 1:120 OAK BROOK CENTER MALL
Practice Address - Street 2:528
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1806
Practice Address - Country:US
Practice Address - Phone:630-571-3430
Practice Address - Fax:630-571-3567
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics