Provider Demographics
NPI:1629140538
Name:LEVINE, ERIC D (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:D
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 1:3416 OLANDWOOD COURT
Mailing Address - Street 2:SUITE 206
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832
Mailing Address - Country:US
Mailing Address - Phone:301-774-2683
Mailing Address - Fax:301-774-9110
Practice Address - Street 1:3416 OLANDWOOD COURT,
Practice Address - Street 2:SUITE 206
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832
Practice Address - Country:US
Practice Address - Phone:301-774-2683
Practice Address - Fax:301-774-9110
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD110571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice