Provider Demographics
NPI:1659164788
Name:DUTRA COSTA, LEVI (DDS)
Entity type:Individual
Prefix:DR
First Name:LEVI
Middle Name:
Last Name:DUTRA COSTA
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 1:3061 WHITE ORCHID RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34747-3047
Mailing Address - Country:US
Mailing Address - Phone:858-262-1616
Mailing Address - Fax:
Practice Address - Street 1:22901 MILLCREEK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5701
Practice Address - Country:US
Practice Address - Phone:216-727-0234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH004899390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program