Healthcare Provider Details

I. General information

NPI: 1922113729
Provider Name (Legal Business Name): NORMAN STEPHEN LEVY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
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

8115 SPLIT OAK DR
BETHESDA MD
20817-6937
US

V. Phone/Fax

Practice location:
  • Phone: 703-491-5166
  • Fax:
Mailing address:
  • Phone: 301-469-6649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4492
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: