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General NPI Number Information
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NPI Number | 1417339698
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Entity Type | Individual
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Provider Name | JACOB LEVINE-SISSON D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/24/2015
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Last Update Date | 06/24/2015
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Provider Practice Location Address
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Address Line | 5415 W CEDAR LN SUITE 108-B
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City | BETHESDA
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State | MD
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Zip | 20814-1515
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Country | US
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Telephone | 301-530-4502
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Fax |
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Provider Business Mailing Address
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Address Line | 101 W READ ST APT. 303
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City | BALTIMORE
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State | MD
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Zip | 21201-4912
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Country | US
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Telephone | 301-461-2555
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 15955
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License Number State | MD
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