Healthcare Provider Details

I. General information

NPI: 1700875663
Provider Name (Legal Business Name): STEPHEN CHARLES LEVIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 ROCK SPRING RD
FOREST HILL MD
21050-2611
US

IV. Provider business mailing address

2003 ROCK SPRING RD
FOREST HILL MD
21050-2611
US

V. Phone/Fax

Practice location:
  • Phone: 410-879-3566
  • Fax: 410-879-7910
Mailing address:
  • Phone: 410-879-3566
  • Fax: 410-879-7910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number4491
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: