MEDICARE: DR. ROBERT EDWARD LEVENS D.D.S.

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
1	122300000X	Dentist	10690	SC
2	1223G0001X	General Practice Dentistry	16977	TX
3	122300000X	Dentist	9267	CO

General Provider Information

NPI Number	:	1700903671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT EDWARD LEVENS D.D.S.

Provider Business Mailing Address
First Line	:	2 WOODHUE CT
Second Line	:
City	:	LUFKIN
State	:	TX
Zip	:	75904-4318
Country	:	US
Telephone Number	:	936-240-3365
Fax Number	:

Provider Business Practice Location Address
First Line	:	8605 MONTAGUE LN
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-4504
Country	:	US
Telephone Number	:	843-650-5100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	09/18/2024

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