Provider Demographics
NPI:1174702179
Name:LEVINE, LAWRENCE GERALD (DDS)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:GERALD
Last Name:LEVINE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8363 RESEDA BLVD
Mailing Address - Street 2:#202
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-5908
Mailing Address - Country:US
Mailing Address - Phone:818-885-0536
Mailing Address - Fax:818-885-1629
Practice Address - Street 1:8363 RESEDA BLVD
Practice Address - Street 2:#202
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-5908
Practice Address - Country:US
Practice Address - Phone:818-885-0536
Practice Address - Fax:818-885-1629
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice