Basic Information
| Provider Information | |||||||||
| NPI: | 1265780472 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVY | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | HERBERT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2811 BUSINESS CENTER DR # PEARLAND | ||||||||
| Address2: | 105 | ||||||||
| City: | PEARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775842149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133401418 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2811 BUSINESS CENTER DR # PEARLAND | ||||||||
| Address2: | 105 | ||||||||
| City: | PEARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775842149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133401418 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2012 | ||||||||
| LastUpdateDate: | 06/20/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 056263 | NY | N | Dental Providers | Dentist | 122300000X | 29897 | TX | Y | Dental Providers | Dentist |
No ID Information.