MEDICARE: DR. AUDREY R LEVINE DDS

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	DN10610	FL

General Provider Information

NPI Number	:	1942891809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUDREY R LEVINE DDS

Provider Business Mailing Address
First Line	:	7126 BERACASA WAY
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-3448
Country	:	US
Telephone Number	:	561-391-6500
Fax Number	:

Provider Business Practice Location Address
First Line	:	7126 BERACASA WAY
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-3448
Country	:	US
Telephone Number	:	561-391-6500
Fax Number	:

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

Provider Enumeration Date	:	02/02/2021
Last Update Date	:	02/02/2021

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