# LA DENTAL INC LEVI EVALT DDS DENTAL EXCELLENCE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114523487
- **Authorized official:** LEVI ROBERT EVALT DDS (OWNER)
- **Authorized official phone:** (814) 664-2012

## Contact information

- **Practice address:** 209 N CENTER ST, CORRY, PA 16407-1626
- **Practice address phone:** (814) 664-2012
- **Practice address fax:** (814) 964-4055
- **Mailing address:** 209 N CENTER ST, CORRY, PA 16407-1626
- **Mailing address phone:** (814) 664-2012
- **Mailing address fax:** (814) 964-4055

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 12/10/2020
- **Last updated:** 12/10/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000870813 | — | PA |
| 05 | — | 001967890 | — | PA |
| 05 | — | 102543929 | — | PA |