Provider Demographics
NPI:1548306962
Name:LEVINE, JEFFREY (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:LEVINE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4700
Mailing Address - Country:US
Mailing Address - Phone:925-447-5110
Mailing Address - Fax:925-373-6568
Practice Address - Street 1:2807 EAST AVE
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4700
Practice Address - Country:US
Practice Address - Phone:925-447-5110
Practice Address - Fax:925-373-6568
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA460991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice