Provider Demographics
NPI:1568471324
Name:LEVATINO, SAMUEL RAY (DDS, LTD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:RAY
Last Name:LEVATINO
Suffix:
Gender:M
Credentials:DDS, LTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10028 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2723
Mailing Address - Country:US
Mailing Address - Phone:225-296-5980
Mailing Address - Fax:225-296-0218
Practice Address - Street 1:10028 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2723
Practice Address - Country:US
Practice Address - Phone:225-296-5980
Practice Address - Fax:225-296-0218
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA25441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA70758Medicaid