Healthcare Provider Details

I. General information

NPI: 1629241781
Provider Name (Legal Business Name): BENJAMIN LEVI DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2082 BUSINESS CENTER DR STE 280
IRVINE CA
92612-1153
US

IV. Provider business mailing address

2082 BUSINESS CENTER DR STE 280
IRVINE CA
92612-1153
US

V. Phone/Fax

Practice location:
  • Phone: 949-514-4190
  • Fax:
Mailing address:
  • Phone: 949-514-4190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number55760
License Number StateCA

VIII. Authorized Official

Name: BENJAMIN LEVI
Title or Position: PRESIDENT
Credential:
Phone: 949-514-4190