Provider Demographics
NPI:1710132873
Name:ROBERT A LEVY DMD LLC
Entity Type:Organization
Organization Name:ROBERT A LEVY DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:314-569-0106
Mailing Address - Street 1:777 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 322 E
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8705
Mailing Address - Country:US
Mailing Address - Phone:314-569-0106
Mailing Address - Fax:
Practice Address - Street 1:777 S NEW BALLAS RD
Practice Address - Street 2:SUITE 322 E
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8705
Practice Address - Country:US
Practice Address - Phone:314-569-0106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO13563261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental