Provider Demographics
NPI:1710186176
Name:EDWARD E. LEVY 111 DDS, A PROFESSIONAL CORP.
Entity Type:Organization
Organization Name:EDWARD E. LEVY 111 DDS, A PROFESSIONAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-283-5549
Mailing Address - Street 1:7037 CANAL BLVD
Mailing Address - Street 2:SUITE 206-207
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-3453
Mailing Address - Country:US
Mailing Address - Phone:504-283-5549
Mailing Address - Fax:504-288-9592
Practice Address - Street 1:7037 CANAL BLVD
Practice Address - Street 2:SUITE 206-207
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-3453
Practice Address - Country:US
Practice Address - Phone:504-283-5549
Practice Address - Fax:504-288-9592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3168261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental