Healthcare Provider Details

I. General information

NPI: 1760507008
Provider Name (Legal Business Name): RICHARD M. LEVINE, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 W BUSCH BLVD
TAMPA FL
33612-7709
US

IV. Provider business mailing address

1311 W BUSCH BLVD
TAMPA FL
33612-7709
US

V. Phone/Fax

Practice location:
  • Phone: 813-935-3585
  • Fax: 813-930-9211
Mailing address:
  • Phone: 813-935-3585
  • Fax: 813-930-9211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number5871
License Number StateFL

VIII. Authorized Official

Name: DR. RICHARD M. LEVINE
Title or Position: PRESIDENT
Credential: DDS
Phone: 813-935-3585