Provider Demographics
NPI:1790888105
Name:MICHAEL D. LEVY, D.M.D., P.C.
Entity Type:Organization
Organization Name:MICHAEL D. LEVY, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOMACKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-855-0707
Mailing Address - Street 1:704 S BROAD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-5242
Mailing Address - Country:US
Mailing Address - Phone:215-855-0707
Mailing Address - Fax:215-855-8901
Practice Address - Street 1:704 SOUTH BROAD STREET
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-5242
Practice Address - Country:US
Practice Address - Phone:215-855-0708
Practice Address - Fax:215-855-8901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026541L122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty