MEDICARE: DR. ROBERT ALLEN LEVINE 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	1223G0001X	General Practice Dentistry	0401005723	VA

General Provider Information

NPI Number	:	1811960842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT ALLEN LEVINE D.D.S.

Provider Business Mailing Address
First Line	:	3918 PROSPERITY AVE
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-3333
Country	:	US
Telephone Number	:	703-280-1300
Fax Number	:	703-280-1314

Provider Business Practice Location Address
First Line	:	3918 PROSPERITY AVE
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-3333
Country	:	US
Telephone Number	:	703-280-1300
Fax Number	:	703-280-1314

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

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	05/05/2020

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