Provider Demographics
NPI:1972811867
Name:LEVY, MICHAEL DAVID (DMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:LEVY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 W UNION HILLS DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-5163
Mailing Address - Country:US
Mailing Address - Phone:877-227-9892
Mailing Address - Fax:623-321-6268
Practice Address - Street 1:333 E LANCASTER AVE
Practice Address - Street 2:STE 363
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-1929
Practice Address - Country:US
Practice Address - Phone:877-227-9892
Practice Address - Fax:623-321-6268
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026541L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist