Provider Demographics
NPI:1942649132
Name:LEVY, NAOMI (DMD)
Entity Type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:
Last Name:LEVY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ESSEX GREEN DR
Mailing Address - Street 2:SUITE 21
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2929
Mailing Address - Country:US
Mailing Address - Phone:978-538-5201
Mailing Address - Fax:978-538-5203
Practice Address - Street 1:5 ESSEX GREEN DR
Practice Address - Street 2:SUITE 21
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2929
Practice Address - Country:US
Practice Address - Phone:978-538-5201
Practice Address - Fax:978-538-5203
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18562781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice