Provider Demographics
NPI:1811918477
Name:LEVY, JONATHAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:LEVY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 MONMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:W LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1029
Mailing Address - Country:US
Mailing Address - Phone:732-229-8118
Mailing Address - Fax:732-229-4732
Practice Address - Street 1:223 MONMOUTH RD
Practice Address - Street 2:
Practice Address - City:W LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1029
Practice Address - Country:US
Practice Address - Phone:732-229-8118
Practice Address - Fax:732-229-4732
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ115251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice