Provider Demographics
NPI:1699285148
Name:LEVY, JOANN ALVINE (DDS)
Entity type:Individual
Prefix:DR
First Name:JOANN
Middle Name:ALVINE
Last Name:LEVY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2179 E OLYMPIC AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-5157
Mailing Address - Country:US
Mailing Address - Phone:559-908-8469
Mailing Address - Fax:
Practice Address - Street 1:2179 E OLYMPIC AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93730-5157
Practice Address - Country:US
Practice Address - Phone:559-908-8469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40791122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist