Provider Demographics
NPI:1851844781
Name:VITALY LEVINTOV
Entity Type:Organization
Organization Name:VITALY LEVINTOV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VITALY
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEVINTOV
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-407-2068
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 1:3140 SHADY LILY LN
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-8018
Practice Address - Country:US
Practice Address - Phone:813-407-2068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22210261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental