Provider Demographics
NPI:1366594038
Name:LEVY, STUART (DDS)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:
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 1:30 JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-9283
Mailing Address - Country:US
Mailing Address - Phone:609-654-4111
Mailing Address - Fax:609-654-1901
Practice Address - Street 1:30 JACKSON RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-9283
Practice Address - Country:US
Practice Address - Phone:609-654-4111
Practice Address - Fax:609-654-1901
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI012372001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice