Provider Demographics
NPI:1154352425
Name:LEVIN, SCOTT NEIL (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:NEIL
Last Name:LEVIN
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 1:8625 N DEAN CIR
Mailing Address - Street 2:
Mailing Address - City:RIVER HILLS
Mailing Address - State:WI
Mailing Address - Zip Code:53217-2038
Mailing Address - Country:US
Mailing Address - Phone:414-351-1751
Mailing Address - Fax:414-351-2735
Practice Address - Street 1:11711 W BURLEIGH ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-3108
Practice Address - Country:US
Practice Address - Phone:414-777-3800
Practice Address - Fax:414-777-3839
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001814-0151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33417400Medicaid