Provider Demographics
NPI:1982911194
Name:LEVI, MARSHA TAVAKOLI (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:TAVAKOLI
Last Name:LEVI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32235 MISSION TRL
Mailing Address - Street 2:SUITE 8
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-4527
Mailing Address - Country:US
Mailing Address - Phone:951-674-6808
Mailing Address - Fax:951-674-2668
Practice Address - Street 1:32235 MISSION TRL
Practice Address - Street 2:SUITE 8
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4527
Practice Address - Country:US
Practice Address - Phone:951-674-6808
Practice Address - Fax:951-674-2668
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46223122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist