Provider Demographics
NPI:1679720577
Name:BODAK-GYOVAI, LEVENTE ZSOLT (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEVENTE
Middle Name:ZSOLT
Last Name:BODAK-GYOVAI
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 1:50 WYNCROFT DR
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-4842
Mailing Address - Country:US
Mailing Address - Phone:610-565-2868
Mailing Address - Fax:
Practice Address - Street 1:50 WYNCROFT DR
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-4842
Practice Address - Country:US
Practice Address - Phone:610-565-2868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018849L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice