Provider Demographics
NPI:1316983638
Name:LEVINE, LARRY ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:ALAN
Last Name:LEVINE
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 1:7126 BERACASA WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3448
Mailing Address - Country:US
Mailing Address - Phone:561-391-6500
Mailing Address - Fax:561-391-9915
Practice Address - Street 1:7070 BERACASA WAY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3447
Practice Address - Country:US
Practice Address - Phone:561-391-6500
Practice Address - Fax:561-391-9915
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL116331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice