Provider Demographics
NPI:1811911910
Name:LEVY, ROBERT S (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:LEVY
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 1:914 COLUMBUS DR
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-6610
Mailing Address - Country:US
Mailing Address - Phone:201-837-1758
Mailing Address - Fax:
Practice Address - Street 1:521 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2791
Practice Address - Country:US
Practice Address - Phone:201-991-1280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ109151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice