Healthcare Provider Details

I. General information

NPI: 1407973274
Provider Name (Legal Business Name): MARVIN LEVENTER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2007
Last Update Date: 10/26/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W BALTIMORE ST RM 5201
BALTIMORE MD
21201-1510
US

IV. Provider business mailing address

650 W BALTIMORE ST STE 5201
BALTIMORE MD
21201-1510
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-5806
  • Fax: 410-706-3028
Mailing address:
  • Phone: 410-706-2470
  • Fax: 410-706-4031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number11703
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS028893L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11703
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: