Healthcare Provider Details

I. General information

NPI: 1275577058
Provider Name (Legal Business Name): HILZENRATH AND LEVINE ORTHODONTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21A MUZZEY ST
LEXINGTON MA
02421-5202
US

IV. Provider business mailing address

21A MUZZEY ST
LEXINGTON MA
02421-5202
US

V. Phone/Fax

Practice location:
  • Phone: 781-860-9473
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number21310
License Number StateMA

VIII. Authorized Official

Name: DR. SAM LEVINE
Title or Position: DOCTOR
Credential: DDS, MS
Phone: 781-860-9473