Provider Demographics
NPI:1710062138
Name:LEVIN, ALYSSA (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:
Last Name:LEVIN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21050 N TATUM BLVD
Mailing Address - Street 2:STE. D202
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4260
Mailing Address - Country:US
Mailing Address - Phone:480-419-2222
Mailing Address - Fax:480-419-9222
Practice Address - Street 1:21050 N TATUM BLVD
Practice Address - Street 2:STE. D202
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4260
Practice Address - Country:US
Practice Address - Phone:480-419-2222
Practice Address - Fax:480-419-9222
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD68181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics