Provider Demographics
NPI:1891702544
Name:LEVY, BARRY WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:WAYNE
Last Name:LEVY
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 1:4801 RITCHIE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215
Mailing Address - Country:US
Mailing Address - Phone:410-789-5228
Mailing Address - Fax:410-789-2102
Practice Address - Street 1:4801 RITCHIE HIGHWAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215
Practice Address - Country:US
Practice Address - Phone:410-789-5228
Practice Address - Fax:410-789-2102
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD7069122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist