Healthcare Provider Details

I. General information

NPI: 1023001104
Provider Name (Legal Business Name): RICHARD B LEVY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 04/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 MILITARY RD NW UNIT #603
WASHINGTON DC
20015
US

IV. Provider business mailing address

4301 MILITARY RD NW UNIT #603
WASHINGTON DC
20015
US

V. Phone/Fax

Practice location:
  • Phone: 860-280-7678
  • Fax:
Mailing address:
  • Phone: 860-280-7678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number4064
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4064
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: