Healthcare Provider Details

I. General information

NPI: 1285083600
Provider Name (Legal Business Name): DLV LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 BOSTON POST RD
MILFORD CT
06460-2574
US

IV. Provider business mailing address

321 BOSTON POST RD
MILFORD CT
06460-2574
US

V. Phone/Fax

Practice location:
  • Phone: 203-433-5439
  • Fax:
Mailing address:
  • Phone: 203-433-5439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number5038
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5038
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number5038
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5038
License Number StateCT

VIII. Authorized Official

Name: DR. JOHN STUART LEVY
Title or Position: PARTNER
Credential: DDS
Phone: 203-393-1333