Provider Demographics
NPI:1760510390
Name:LEVINE, PAUL EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:EDWARD
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 1:6707 OLD DOMINION DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4504
Mailing Address - Country:US
Mailing Address - Phone:703-356-3960
Mailing Address - Fax:703-356-1574
Practice Address - Street 1:6707 OLD DOMINION DR
Practice Address - Street 2:SUITE 230
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4504
Practice Address - Country:US
Practice Address - Phone:703-356-3960
Practice Address - Fax:703-356-1574
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4115122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist