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
—
—
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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