=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679589857
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRETT R LEVIN D.M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6825 E TENNESSEE AVE STE 621
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80224-1634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-333-2221
-----------------------------------------------------
Fax | 303-377-4876
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6825 E TENNESSEE AVE STE 621
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80224-1634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-333-2221
-----------------------------------------------------
Fax | 303-377-4876
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 8357
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------