MEDICARE: DR. PAUL DAVID 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	1223G0001X	General Practice Dentistry	13476	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	678927	OTHER	TX	UNITED CONCORDIA

General Provider Information

NPI Number	:	1659376481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL DAVID LEVINE D.D.S.

Provider Business Mailing Address
First Line	:	13111 WESTHEIMER RD
Second Line	:	STE 250
City	:	HOUSTON
State	:	TX
Zip	:	77077-5520
Country	:	US
Telephone Number	:	281-759-2626
Fax Number	:	281-759-2634

Provider Business Practice Location Address
First Line	:	13111 WESTHEIMER RD
Second Line	:	STE 250
City	:	HOUSTON
State	:	TX
Zip	:	77077-5520
Country	:	US
Telephone Number	:	281-759-2626
Fax Number	:	281-759-2634

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	07/08/2007

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