Provider Demographics
NPI:1780833863
Name:LEVINE, MEREDITH ELLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:ELLEN
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 1:2080 CENTURY PARK EAST
Mailing Address - Street 2:SUITE 1516
Mailing Address - City:CENTURY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90067
Mailing Address - Country:US
Mailing Address - Phone:424-358-3811
Mailing Address - Fax:310-553-1612
Practice Address - Street 1:2080 CENTURY PARK EAST
Practice Address - Street 2:SUITE 1516
Practice Address - City:CENTURY CITY
Practice Address - State:CA
Practice Address - Zip Code:90067
Practice Address - Country:US
Practice Address - Phone:424-358-3811
Practice Address - Fax:310-553-1612
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA418491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice