Provider Demographics
NPI:1548337876
Name:LEVENSON, LANNY R (DDS)
Entity type:Individual
Prefix:DR
First Name:LANNY
Middle Name:R
Last Name:LEVENSON
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 1:1507 HUGUENOT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2485
Mailing Address - Country:US
Mailing Address - Phone:804-379-9800
Mailing Address - Fax:804-379-9956
Practice Address - Street 1:1507 HUGUENOT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2485
Practice Address - Country:US
Practice Address - Phone:804-379-9800
Practice Address - Fax:804-379-9956
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA053311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice