Provider Demographics
NPI:1669693420
Name:LEVIN, DENNIS (LAC)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:LEVIN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 471
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-0471
Mailing Address - Country:US
Mailing Address - Phone:206-851-1294
Mailing Address - Fax:206-463-4714
Practice Address - Street 1:18017 VASHON HWY SW
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-5205
Practice Address - Country:US
Practice Address - Phone:206-851-1294
Practice Address - Fax:206-463-4714
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000648171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist