MEDICARE: DR. KENNETH R LEVINE D.D.S.

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	1223P0300X	Periodontics	DN6044	FL

General Provider Information

NPI Number	:	1336284413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH R LEVINE D.D.S.

Provider Business Mailing Address
First Line	:	8333 W MCNAB RD STE 104
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321-3203
Country	:	US
Telephone Number	:	954-722-1100
Fax Number	:	954-722-1434

Provider Business Practice Location Address
First Line	:	8333 W MCNAB RD STE 104
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321-3203
Country	:	US
Telephone Number	:	954-722-1100
Fax Number	:	954-722-1434

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	02/07/2012

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