Provider Demographics
NPI:1174813760
Name:MITCHELL LEVITT, DMD, A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:MITCHELL LEVITT, DMD, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVITT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:323-934-9588
Mailing Address - Street 1:5757 WILSHIRE BLVD STE 559
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3683
Mailing Address - Country:US
Mailing Address - Phone:323-934-9588
Mailing Address - Fax:323-934-9618
Practice Address - Street 1:5757 WILSHIRE BLVD STE 559
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-3683
Practice Address - Country:US
Practice Address - Phone:323-934-9588
Practice Address - Fax:323-934-9618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty