Healthcare Provider Details

I. General information

NPI: 1912053869
Provider Name (Legal Business Name): MARK D. LEVENSON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5869 W ATLANTIC AVE
DELRAY BEACH FL
33484-8402
US

IV. Provider business mailing address

3049 NW 25TH TER
BOCA RATON FL
33434-3620
US

V. Phone/Fax

Practice location:
  • Phone: 561-637-9300
  • Fax:
Mailing address:
  • Phone: 561-852-2149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN 7829
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: