Provider Demographics
NPI:1619188760
Name:LEVINSON, NADINE ANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:NADINE
Middle Name:ANNE
Last Name:LEVINSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30011 IVY GLENN DR STE 105
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-5015
Mailing Address - Country:US
Mailing Address - Phone:949-495-3332
Mailing Address - Fax:949-496-0723
Practice Address - Street 1:30011 IVY GLENN DR STE 105
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-5015
Practice Address - Country:US
Practice Address - Phone:949-495-3332
Practice Address - Fax:949-496-0723
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARP033102L00000X
CAD21031122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No122300000XDental ProvidersDentist