Provider Demographics
NPI:1609008812
Name:LEVINE, CARLY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLY
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 1:881 ALMA REAL DR
Mailing Address - Street 2:SUITE T2
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3731
Mailing Address - Country:US
Mailing Address - Phone:310-459-2303
Mailing Address - Fax:310-459-0015
Practice Address - Street 1:881 ALMA REAL DR
Practice Address - Street 2:SUITE T2
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3731
Practice Address - Country:US
Practice Address - Phone:310-459-2303
Practice Address - Fax:310-459-0015
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA585071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice