MEDICARE: MICHAEL D. LEVY, D.M.D., P.C.

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	DS026541L	PA

General Provider Information

NPI Number	:	1790888105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL D. LEVY, D.M.D., P.C.

Provider Business Mailing Address
First Line	:	704 S BROAD ST STE 1
Second Line	:
City	:	LANSDALE
State	:	PA
Zip	:	19446-5242
Country	:	US
Telephone Number	:	215-855-0707
Fax Number	:	215-855-8901

Provider Business Practice Location Address
First Line	:	704 SOUTH BROAD STREET
Second Line	:
City	:	LANSDALE
State	:	PA
Zip	:	19446-5242
Country	:	US
Telephone Number	:	215-855-0708
Fax Number	:	215-855-8901

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JENNIFER B HOMACKI
Credential	:
Telephone Number	:	215-855-0707

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	12/18/2018

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