Provider Demographics
NPI:1508036369
Name:LEVINE, MARTIN JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JAMES
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 1:6175 SOM CENTER RD
Mailing Address - Street 2:SUITE 235
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2965
Mailing Address - Country:US
Mailing Address - Phone:440-248-6684
Mailing Address - Fax:440-248-6096
Practice Address - Street 1:6175 SOM CENTER RD
Practice Address - Street 2:SUITE 235
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2965
Practice Address - Country:US
Practice Address - Phone:440-248-6684
Practice Address - Fax:440-248-6096
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-08
Last Update Date:2008-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15472122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist