Provider Demographics
NPI:1811269277
Name:LEVITTOWN DENTAL
Entity type:Organization
Organization Name:LEVITTOWN DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPIETARIO
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-565-8049
Mailing Address - Street 1:CALLE 11 A-7 URB.SAN SOUCI
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:787-565-8049
Mailing Address - Fax:
Practice Address - Street 1:CALLE 11 A-7 URB.SAN SOUCI
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-565-8049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty