MEDICARE: MICHAEL C LEVINE DMD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	8146	NC

General Provider Information

NPI Number	:	1447420823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL C LEVINE DMD PA

Provider Business Mailing Address
First Line	:	1135 MILITARY CUTOFF RD
Second Line	:	SUITE 204
City	:	WILMINGTON
State	:	NC
Zip	:	28405-3966
Country	:	US
Telephone Number	:	910-256-9142
Fax Number	:

Provider Business Practice Location Address
First Line	:	1135 MILITARY CUTOFF RD
Second Line	:	SUITE 204
City	:	WILMINGTON
State	:	NC
Zip	:	28405-3966
Country	:	US
Telephone Number	:	910-256-9142
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MRS. DIANE C LEVINE
Credential	:
Telephone Number	:	910-256-9141

Provider Enumeration Date	:	03/03/2008
Last Update Date	:	03/03/2008

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