1174702179 NPI number — MR. LAWRENCE GERALD LEVINE DDS

Table of content: MR. LAWRENCE GERALD LEVINE DDS (NPI 1174702179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174702179 NPI number — MR. LAWRENCE GERALD LEVINE DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVINE
Provider First Name:
LAWRENCE
Provider Middle Name:
GERALD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174702179
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8363 RESEDA BLVD
Provider Second Line Business Mailing Address:
#202
Provider Business Mailing Address City Name:
NORTHRIDGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91324-5908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-885-0536
Provider Business Mailing Address Fax Number:
818-885-1629

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8363 RESEDA BLVD
Provider Second Line Business Practice Location Address:
#202
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91324-5908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-885-0536
Provider Business Practice Location Address Fax Number:
818-885-1629
Provider Enumeration Date:
10/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  22522 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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