MEDICARE: RANDI B LEVINE DENTIST

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	122300000X	Dentist	HAD 17	FL

General Provider Information

NPI Number	:	1679814131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDI B LEVINE DENTIST

Provider Business Mailing Address
First Line	:	1290 GOLFVIEW AVE
Second Line	:	ATTN: ACCOUNTS RECEIVABLE
City	:	BARTOW
State	:	FL
Zip	:	33830-6740
Country	:	US
Telephone Number	:	863-519-7900
Fax Number	:	863-519-7696

Provider Business Practice Location Address
First Line	:	1700 BAKER AVENUE E
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-4325
Country	:	US
Telephone Number	:	863-419-3252
Fax Number	:	863-419-3497

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

Provider Enumeration Date	:	03/08/2013
Last Update Date	:	03/08/2013

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