Provider Demographics
NPI:1144306275
Name:LEVINE, ROBERT A (DDS, PC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:LEVINE
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9880 BUSTLETON AVE
Mailing Address - Street 2:SUITE 211-212
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-2185
Mailing Address - Country:US
Mailing Address - Phone:215-677-8686
Mailing Address - Fax:215-677-7212
Practice Address - Street 1:9880 BUSTLETON AVE
Practice Address - Street 2:SUITE 211-212
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-2185
Practice Address - Country:US
Practice Address - Phone:215-677-8686
Practice Address - Fax:215-677-7212
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-022257-L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics