Provider Demographics
NPI:1699309856
Name:LEVICOFF, MARC (DMD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:LEVICOFF
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 1:16 GALENA CT
Mailing Address - Street 2:
Mailing Address - City:ERIAL
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-4321
Mailing Address - Country:US
Mailing Address - Phone:856-383-0673
Mailing Address - Fax:
Practice Address - Street 1:313 S LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-2815
Practice Address - Country:US
Practice Address - Phone:813-653-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program