Provider Demographics
NPI:1245504950
Name:LEVISON DENTAL GROUP PC
Entity type:Organization
Organization Name:LEVISON DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/SEC
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-699-1809
Mailing Address - Street 1:9 MONROE PKWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-1495
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9 MONROE PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-1495
Practice Address - Country:US
Practice Address - Phone:503-699-1809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty