Provider Demographics
NPI:1265780472
Name:LEVY, STEPHEN HERBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:HERBERT
Last Name:LEVY
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 1:2811 BUSINESS CENTER DR # PEARLAND
Mailing Address - Street 2:105
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-2149
Mailing Address - Country:US
Mailing Address - Phone:713-340-1418
Mailing Address - Fax:
Practice Address - Street 1:2811 BUSINESS CENTER DR # PEARLAND
Practice Address - Street 2:105
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-2149
Practice Address - Country:US
Practice Address - Phone:713-340-1418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-17
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056263122300000X
TX29897122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist