Provider Demographics
NPI:1225173446
Name:LEVINE, URSULA (DDS)
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:
Last Name:LEVINE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 OSBORN ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4690
Mailing Address - Country:US
Mailing Address - Phone:949-727-9600
Mailing Address - Fax:949-552-5980
Practice Address - Street 1:2 OSBORN ST
Practice Address - Street 2:SUITE 130
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4690
Practice Address - Country:US
Practice Address - Phone:949-727-9600
Practice Address - Fax:949-552-5980
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA489501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice