Provider Demographics
NPI:1598062978
Name:MITCHELL R LEVINE DMD PA
Entity Type:Organization
Organization Name:MITCHELL R LEVINE DMD PA
Other - Org Name:JACKSONVILLE DENTAL SLEEP MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-737-4626
Mailing Address - Street 1:3600 CARDINAL POINT DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5581
Mailing Address - Country:US
Mailing Address - Phone:904-737-4626
Mailing Address - Fax:904-737-2126
Practice Address - Street 1:3600 CARDINAL POINT DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5581
Practice Address - Country:US
Practice Address - Phone:904-737-4626
Practice Address - Fax:904-737-2126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-20
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10789122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6490610001Medicare NSC