Provider Demographics
NPI:1740391465
Name:LEVINE, LAURENCE JAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:JAY
Last Name:LEVINE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2243 CASSATT DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-5065
Mailing Address - Country:US
Mailing Address - Phone:954-849-1753
Mailing Address - Fax:
Practice Address - Street 1:2610 W HORIZON RIDGE PKWY STE 202
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2870
Practice Address - Country:US
Practice Address - Phone:702-270-4600
Practice Address - Fax:702-270-7773
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN47831223P0221X
NVS4-113C1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223P0221XDental ProvidersDentistPediatric Dentistry