Provider Demographics
NPI:1609329994
Name:LEVINTOV, VITALY G (DMD)
Entity Type:Individual
Prefix:DR
First Name:VITALY
Middle Name:G
Last Name:LEVINTOV
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33160 US 19 N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3127
Mailing Address - Country:US
Mailing Address - Phone:813-563-0872
Mailing Address - Fax:
Practice Address - Street 1:33160 US 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3127
Practice Address - Country:US
Practice Address - Phone:813-563-0872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22210122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist