Provider Demographics
NPI:1447510557
Name:LEVINE, ROSS STEVEN (DMD)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:STEVEN
Last Name:LEVINE
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 1:199 14TH ST NE APT 2704
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3692
Mailing Address - Country:US
Mailing Address - Phone:770-356-2493
Mailing Address - Fax:
Practice Address - Street 1:200 GALLERIA PKWY SE
Practice Address - Street 2:SUITE 1830
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5918
Practice Address - Country:US
Practice Address - Phone:770-356-2493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0142881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice