Provider Demographics
NPI:1417084773
Name:THEODORE M LEVINE, DDS, PC
Entity Type:Organization
Organization Name:THEODORE M LEVINE, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:412-823-4444
Mailing Address - Street 1:400 PENN CENTER BLVD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-5613
Mailing Address - Country:US
Mailing Address - Phone:412-823-4444
Mailing Address - Fax:412-823-6556
Practice Address - Street 1:400 PENN CENTER BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-5613
Practice Address - Country:US
Practice Address - Phone:412-823-4444
Practice Address - Fax:412-823-6556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty