Provider Demographics
NPI:1447420823
Name:MICHAEL C LEVINE DMD PA
Entity Type:Organization
Organization Name:MICHAEL C LEVINE DMD PA
Other - Org Name:LANDFALL DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-256-9141
Mailing Address - Street 1:1135 MILITARY CUTOFF RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3966
Mailing Address - Country:US
Mailing Address - Phone:910-256-9142
Mailing Address - Fax:
Practice Address - Street 1:1135 MILITARY CUTOFF RD
Practice Address - Street 2:SUITE 204
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3966
Practice Address - Country:US
Practice Address - Phone:910-256-9142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8146122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty