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NPI Code Detail

MEDICARE: MARK S LEVIN DDS

MEDICARE: MARK S LEVIN DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0221XPediatric Dentistry0401005706VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1021357OTHERVAUNITED CONCORDIA

General Provider Information

NPI Number : 1073620746
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK S LEVIN DDS
Provider Business Mailing Address
First Line : 1055 KEMPSVILLE RD
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23464-5501
Country : US
Telephone Number : 757-474-1200
Fax Number : 757-474-9392
Provider Business Practice Location Address
First Line : 1055 KEMPSVILLE RD
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23464-5501
Country : US
Telephone Number : 757-474-1200
Fax Number : 757-474-9392
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2006
Last Update Date : 07/08/2007

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