Healthcare Provider Details

I. General information

NPI: 1639281744
Provider Name (Legal Business Name): NORMAN S. LEVY, D.D.S., LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12662A LAKE RIDGE DR
WOODBRIDGE VA
22192-2335
US

IV. Provider business mailing address

12662A LAKE RIDGE DR
WOODBRIDGE VA
22192-2335
US

V. Phone/Fax

Practice location:
  • Phone: 703-491-5166
  • Fax:
Mailing address:
  • Phone: 703-491-5166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. NORMAN S. LEVY
Title or Position: PRESIDENT
Credential: DDS
Phone: 703-491-5166