Provider Demographics
NPI:1710121645
Name:LEV TOMASHEVSKY DDS, LLC
Entity Type:Organization
Organization Name:LEV TOMASHEVSKY DDS, LLC
Other - Org Name:ROBERT J KELLY DDS & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTO
Authorized Official - Middle Name:
Authorized Official - Last Name:TATARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-243-0500
Mailing Address - Street 1:220 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5471
Mailing Address - Country:US
Mailing Address - Phone:301-948-0058
Mailing Address - Fax:301-977-3184
Practice Address - Street 1:220 MAIN ST
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-5471
Practice Address - Country:US
Practice Address - Phone:301-948-0058
Practice Address - Fax:301-977-3184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD132801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty