MEDICARE: DR. RON LEVENBAUM DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	16439	MA

General Provider Information

NPI Number	:	1689650798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RON LEVENBAUM DMD

Provider Business Mailing Address
First Line	:	270 LITTLETON RD
Second Line	:	SUITE #9
City	:	WESTFORD
State	:	MA
Zip	:	01886-3526
Country	:	US
Telephone Number	:	978-692-6326
Fax Number	:	978-392-9253

Provider Business Practice Location Address
First Line	:	270 LITTLETON RD
Second Line	:	SUITE #9
City	:	WESTFORD
State	:	MA
Zip	:	01886-3526
Country	:	US
Telephone Number	:	978-692-6326
Fax Number	:	978-392-9253

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	11/20/2015

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