MEDICARE: DR. ALYSSA LEVIN DDS, MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	D6818	AZ

General Provider Information

NPI Number	:	1710062138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALYSSA LEVIN DDS, MS

Provider Business Mailing Address
First Line	:	21050 N TATUM BLVD
Second Line	:	STE. D202
City	:	PHOENIX
State	:	AZ
Zip	:	85050-4260
Country	:	US
Telephone Number	:	480-419-2222
Fax Number	:	480-419-9222

Provider Business Practice Location Address
First Line	:	21050 N TATUM BLVD
Second Line	:	STE. D202
City	:	PHOENIX
State	:	AZ
Zip	:	85050-4260
Country	:	US
Telephone Number	:	480-419-2222
Fax Number	:	480-419-9222

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	09/29/2010

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