MEDICARE: DR. STANLEY MARK LEVENSON

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	1223G0001X	General Practice Dentistry	16437	MA

General Provider Information

NPI Number	:	1750394193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STANLEY MARK LEVENSON

Provider Business Mailing Address
First Line	:	9 LINDEN ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01609-2510
Country	:	US
Telephone Number	:	508-753-3105
Fax Number	:	508-797-3740

Provider Business Practice Location Address
First Line	:	9 LINDEN ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01609-2510
Country	:	US
Telephone Number	:	508-753-3105
Fax Number	:	508-797-3740

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	03/25/2025

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