Provider Demographics
NPI:1770873622
Name:LEVITSKY, BOGDAN V (DMD)
Entity type:Individual
Prefix:DR
First Name:BOGDAN
Middle Name:V
Last Name:LEVITSKY
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 1:7 MYERS DRIVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062
Mailing Address - Country:US
Mailing Address - Phone:856-214-3769
Mailing Address - Fax:856-214-3834
Practice Address - Street 1:7 MYERS DRIVE
Practice Address - Street 2:UNIT A
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062
Practice Address - Country:US
Practice Address - Phone:856-214-3769
Practice Address - Fax:856-214-3834
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1024487001223G0001X
NJ22D1024487021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice