Provider Demographics
NPI:1457394967
Name:LEVY, CHARLES (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:LEVY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:CHARLES
Other - Middle Name:
Other - Last Name:LEVY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:244 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02675-1757
Mailing Address - Country:US
Mailing Address - Phone:508-375-9090
Mailing Address - Fax:508-375-3323
Practice Address - Street 1:244 WILLOW ST
Practice Address - Street 2:
Practice Address - City:YARMOUTH PORT
Practice Address - State:MA
Practice Address - Zip Code:02675-1757
Practice Address - Country:US
Practice Address - Phone:508-375-9090
Practice Address - Fax:508-375-3323
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA118231223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics