Provider Demographics
NPI:1578686846
Name:CA LEVANOS, DDS INC
Entity type:Organization
Organization Name:CA LEVANOS, DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:413-782-5159
Mailing Address - Street 1:1235 SUMNER AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-2160
Mailing Address - Country:US
Mailing Address - Phone:413-782-5159
Mailing Address - Fax:413-783-7094
Practice Address - Street 1:1235 SUMNER AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-2160
Practice Address - Country:US
Practice Address - Phone:413-782-5159
Practice Address - Fax:413-783-7094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA199471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty