Provider Demographics
NPI:1174583868
Name:LEVI, BENJAMIN (DDS)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:LEVI
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 1:19881 BROOKHURST ST STE C-284
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-4269
Mailing Address - Country:US
Mailing Address - Phone:949-514-4190
Mailing Address - Fax:
Practice Address - Street 1:19881 BROOKHURST ST STE C-284
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-4269
Practice Address - Country:US
Practice Address - Phone:949-514-4190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2012-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA557601223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics