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Organization
LA DENTAL INC LEVI EVALT DDS DENTAL EXCELLENCE
Active
Organization
LA DENTAL INC LEVI EVALT DDS DENTAL EXCELLENCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEVI ROBERT EVALT DDS (OWNER)
(814) 664-2012
Entity
Organization
Contact information
Practice address
209 N CENTER ST, CORRY, PA 16407-1626
(814) 664-2012
(814) 964-4055
Mailing address
209 N CENTER ST, CORRY, PA 16407-1626
(814) 664-2012
(814) 964-4055
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000870813
—
PA
05
—
001967890
—
PA
05
—
102543929
—
PA
Enumeration date
12/10/2020
Last updated
12/10/2020
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