Provider Demographics
NPI:1942488952
Name:EVALT, LEVI R (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEVI
Middle Name:R
Last Name:EVALT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407-1626
Mailing Address - Country:US
Mailing Address - Phone:814-664-2012
Mailing Address - Fax:814-664-2012
Practice Address - Street 1:209 N CENTER ST
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-1626
Practice Address - Country:US
Practice Address - Phone:814-664-2012
Practice Address - Fax:814-664-2012
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0304934321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice