Provider Demographics
NPI:1609935634
Name:LEVINE, GERALD M (DMD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:M
Last Name:LEVINE
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 1:4558 S KIRKMAN RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-2848
Mailing Address - Country:US
Mailing Address - Phone:407-294-0067
Mailing Address - Fax:407-294-4060
Practice Address - Street 1:4558 S KIRKMAN RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-2848
Practice Address - Country:US
Practice Address - Phone:407-294-0067
Practice Address - Fax:407-294-4060
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN129971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice