Provider Demographics
NPI:1881700102
Name:LEVINE, BARRY C (DMD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:C
Last Name:LEVINE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5208 E FOWLER AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1906
Mailing Address - Country:US
Mailing Address - Phone:813-985-1066
Mailing Address - Fax:813-985-0821
Practice Address - Street 1:5208 E FOWLER AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-1906
Practice Address - Country:US
Practice Address - Phone:813-985-1066
Practice Address - Fax:813-985-0821
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN8309174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT54891Medicare UPIN