Healthcare Provider Details

I. General information

NPI: 1184962425
Provider Name (Legal Business Name): HARRY A DUNLEVY D.M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DR. JACK DUNLEVY

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11601 ROBIOUS RD STE 130
MIDLOTHIAN VA
23113-5605
US

IV. Provider business mailing address

11601 ROBIOUS RD STE 130
MIDLOTHIAN VA
23113-5605
US

V. Phone/Fax

Practice location:
  • Phone: 804-794-3498
  • Fax: 804-794-8344
Mailing address:
  • Phone: 804-794-3498
  • Fax: 804-794-8344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401006907
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: