Provider Demographics
NPI:1821202649
Name:LEVIN, MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
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 1:322 S LAFAYETTE ST STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-1965
Mailing Address - Country:US
Mailing Address - Phone:616-754-2800
Mailing Address - Fax:616-754-2801
Practice Address - Street 1:322 S LAFAYETTE ST STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-1965
Practice Address - Country:US
Practice Address - Phone:616-754-2800
Practice Address - Fax:616-754-2801
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL114501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIL11450OtherSTATE LICENSE