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General NPI Number Information
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NPI Number | 1912053869
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Entity Type | Individual
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Provider Name | MARK D. LEVENSON D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5869 W ATLANTIC AVE
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City | DELRAY BEACH
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State | FL
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Zip | 33484-8402
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Country | US
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Telephone | 561-637-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 3049 NW 25TH TER
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City | BOCA RATON
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State | FL
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Zip | 33434-3620
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Country | US
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Telephone | 561-852-2149
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN 7829
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License Number State | FL
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