La Dental Inc Levi Evalt DDS Dental Excellence
Organization Active NPI General Practice Dentistry · Corry, PA
NPI 1114523487 · NPPES record last updated Dec 10, 2020
Key facts
- NPI
- 1114523487
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Dentistry 1223G0001X
- Legal business name
- LA DENTAL INC LEVI EVALT DDS DENTAL EXCELLENCE
- Practice address
- 209 N Center St
Corry, PA 16407-1626 - Phone
- (814) 664-2012
- Fax
- (814) 964-4055
- NPI assigned
- Dec 10, 2020
- Organization subpart
- No
Authorized official
- Name
- Levi Robert Evalt, DDS
- Title
- Owner
- Phone
- (814) 664-2012
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | Yes |
Addresses
Primary practice location
209 N Center St
Corry, PA 16407-1626
Mailing address
209 N Center St
Corry, PA 16407-1626
Phone (814) 664-2012
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001967890 | Medicaid | PA | |
| 000870813 | Medicaid | PA | |
| 102543929 | Medicaid | PA |
Other providers in Corry, PA
- Carol Johnson
- Karl E Streilein Optometry, PC
- Matthew Eugene Kellogg
- Cassandra Kiser
- John Joseph Kozik
- Mariano Dulay Loveranes
- Desiree Lucas
- Kurt E Lund
- Thomas C Mack
- Magnus Home Health, LLC
All providers in Corry, PA · General Practice Dentistry in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 10, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.