Provider Demographics
NPI:1013772334
Name:LEVY, M EDWIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:M EDWIN
Middle Name:
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 1:944 MERRITTON ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PICKERING
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L1V 1B1
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:944 MERRITTON ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:PICKERING
Practice Address - State:ONTARIO
Practice Address - Zip Code:L1V 1B1
Practice Address - Country:CA
Practice Address - Phone:905-831-4564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN177521223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics