Provider Demographics
NPI:1619018488
Name:LEVY, LAURENCE KENT (DMD)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:KENT
Last Name:LEVY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3423
Mailing Address - Country:US
Mailing Address - Phone:860-347-4500
Mailing Address - Fax:860-347-5802
Practice Address - Street 1:193 MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3423
Practice Address - Country:US
Practice Address - Phone:860-347-4500
Practice Address - Fax:860-347-5802
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0077251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice