Provider Demographics
NPI:1750563151
Name:LEVINE, GAYLA ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:GAYLA
Middle Name:ANN
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 1:16 JACKMAN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-1670
Mailing Address - Country:US
Mailing Address - Phone:603-965-4209
Mailing Address - Fax:603-965-4209
Practice Address - Street 1:365 EAST ST
Practice Address - Street 2:TEWKSBURY HOSPITAL DENTAL CLINIC
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-1950
Practice Address - Country:US
Practice Address - Phone:978-851-7321
Practice Address - Fax:978-858-3795
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice