Provider Demographics
NPI:1750482238
Name:LEVIN, LARRY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:M
Last Name:LEVIN
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 1:104 E PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:ALDAN
Mailing Address - State:PA
Mailing Address - Zip Code:19018-4127
Mailing Address - Country:US
Mailing Address - Phone:610-623-7710
Mailing Address - Fax:610-626-3142
Practice Address - Street 1:104 E PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:ALDAN
Practice Address - State:PA
Practice Address - Zip Code:19018-4127
Practice Address - Country:US
Practice Address - Phone:610-623-7710
Practice Address - Fax:610-626-3142
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS015663L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice