Provider Demographics
NPI:1063768034
Name:LEVINE, FERNANDA GURGEL (DDS)
Entity type:Individual
Prefix:DR
First Name:FERNANDA
Middle Name:GURGEL
Last Name:LEVINE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6707 OLD DOMINION DR STE 230
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4507
Mailing Address - Country:US
Mailing Address - Phone:202-680-9272
Mailing Address - Fax:
Practice Address - Street 1:6707 OLD DOMINION DR STE 230
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4507
Practice Address - Country:US
Practice Address - Phone:202-680-9272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414679122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist