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General NPI Number Information
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NPI Number | 1740391465
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Entity Type | Individual
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Provider Name | LAURENCE JAY LEVINE DDS
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 2610 W HORIZON RIDGE PKWY STE 202
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City | HENDERSON
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State | NV
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Zip | 89052-2870
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Country | US
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Telephone | 702-270-4600
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Fax | 702-270-7773
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Provider Business Mailing Address
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Address Line | 2243 CASSATT DR
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City | HENDERSON
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State | NV
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Zip | 89074-5065
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Country | US
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Telephone | 954-849-1753
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN4783
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | S4-113C
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License Number State | NV
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