Healthcare Provider Details

I. General information

NPI: 1235238254
Provider Name (Legal Business Name): ANDREW BERNARD LEVIN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 E SOUTHERN AVE STE 5
TEMPE AZ
85282-5685
US

IV. Provider business mailing address

1628 E SOUTHERN AVE STE 5
TEMPE AZ
85282-5685
US

V. Phone/Fax

Practice location:
  • Phone: 480-831-3898
  • Fax:
Mailing address:
  • Phone: 480-831-3898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD009207
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6439
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN014177
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: