Provider Demographics
NPI:1912021528
Name:LEVY, ALLAN C
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:C
Last Name:LEVY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208B VFW PKWY STE 307
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-4350
Mailing Address - Country:US
Mailing Address - Phone:617-325-4100
Mailing Address - Fax:617-325-0006
Practice Address - Street 1:1208B VFW PKWY STE 307
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-4350
Practice Address - Country:US
Practice Address - Phone:617-325-4100
Practice Address - Fax:617-325-0006
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA132861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice