Provider Demographics
NPI:1174603559
Name:LEVY, HARVEY (DMD)
Entity type:Individual
Prefix:
First Name:HARVEY
Middle Name:
Last Name:LEVY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:HARVEY
Other - Middle Name:
Other - Last Name:LEVY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, MAGD
Mailing Address - Street 1:198 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4398
Mailing Address - Country:US
Mailing Address - Phone:301-663-8300
Mailing Address - Fax:301-682-3993
Practice Address - Street 1:198 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 108
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4398
Practice Address - Country:US
Practice Address - Phone:301-663-8300
Practice Address - Fax:301-682-3993
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD070191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice