Provider Demographics
NPI:1689650798
Name:LEVENBAUM, RON (DMD)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:
Last Name:LEVENBAUM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 LITTLETON RD
Mailing Address - Street 2:SUITE #9
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-3526
Mailing Address - Country:US
Mailing Address - Phone:978-692-6326
Mailing Address - Fax:978-392-9253
Practice Address - Street 1:270 LITTLETON RD
Practice Address - Street 2:SUITE #9
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-3526
Practice Address - Country:US
Practice Address - Phone:978-692-6326
Practice Address - Fax:978-392-9253
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA164391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice