Provider Demographics
NPI:1538386313
Name:LEVITAN, MARC (DDS)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:LEVITAN
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:PO BOX 1804
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29465-1804
Mailing Address - Country:US
Mailing Address - Phone:901-830-7110
Mailing Address - Fax:843-792-6433
Practice Address - Street 1:173 ASHLEY AVE RM 440 BSB
Practice Address - Street 2:MUSC - ENDODONTICS
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8908
Practice Address - Country:US
Practice Address - Phone:843-792-3516
Practice Address - Fax:843-792-6433
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC181223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics