=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962553610
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK L LEVY DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2007
-----------------------------------------------------
Last Update Date | 01/13/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1335 DUBLIN RD STE 100B
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43215-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 147-777-3506
-----------------------------------------------------
Fax | 888-390-0424
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1335 DUBLIN RD STE 100B
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43215-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-777-7350
-----------------------------------------------------
Fax | 800-390-3424
-----------------------------------------------------
=====================================================
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 | 30-016150
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------