Provider Demographics
NPI:1922009729
Name:LEVINE, RICHARD M (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:LEVINE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:D
Other - Last Name:DOLGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1311 W BUSCH BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7709
Mailing Address - Country:US
Mailing Address - Phone:813-935-3585
Mailing Address - Fax:813-930-9211
Practice Address - Street 1:1311 W BUSCH BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7709
Practice Address - Country:US
Practice Address - Phone:813-935-3585
Practice Address - Fax:813-930-9211
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 58711223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics