Healthcare Provider Details

I. General information

NPI: 1689650798
Provider Name (Legal Business Name): RON LEVENBAUM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 LITTLETON RD SUITE #9
WESTFORD MA
01886-3526
US

IV. Provider business mailing address

270 LITTLETON RD SUITE #9
WESTFORD MA
01886-3526
US

V. Phone/Fax

Practice location:
  • Phone: 978-692-6326
  • Fax: 978-392-9253
Mailing address:
  • Phone: 978-692-6326
  • Fax: 978-392-9253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16439
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: