Provider Demographics
NPI:1952825648
Name:R.E. LEVI DENTAL CORPORATION
Entity type:Organization
Organization Name:R.E. LEVI DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROYA
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEVI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-677-7779
Mailing Address - Street 1:32235 MISSION # 8
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530
Mailing Address - Country:US
Mailing Address - Phone:951-674-6808
Mailing Address - Fax:951-674-2668
Practice Address - Street 1:32235 MISSION TRAIL # 8
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530
Practice Address - Country:US
Practice Address - Phone:951-674-6808
Practice Address - Fax:951-674-2668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29257122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty