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General NPI Number Information
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NPI Number | 1245383157
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Entity Type | Organization
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Legal Business Name | GERALD M. LEVINE, D.M.D.,P.A.
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 4558 S KIRKMAN RD
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City | ORLANDO
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State | FL
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Zip | 32811-2848
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Country | US
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Telephone | 407-294-0067
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Fax | 407-294-4060
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Provider Business Mailing Address
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Address Line | 4558 S KIRKMAN RD
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City | ORLANDO
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State | FL
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Zip | 32811-2848
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Country | US
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Telephone | 407-294-0067
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Fax | 407-294-4060
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Authorized Official
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Title or Position | OFFICE COORDINATOR
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Name | SUZETTE M LEVINE
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Credential |
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Telephone | 407-294-0067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12997
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License Number State | FL
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