Basic Information
| Provider Information | |||||||||
| NPI: | 1588811632 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVINE | ||||||||
| FirstName: | COURTNEY | ||||||||
| MiddleName: | RUBIN | ||||||||
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| Credential: | DDS | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2221 HAYES AVE | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434202632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193348855 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2221 HAYES AVE | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434202632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193348855 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2008 | ||||||||
| LastUpdateDate: | 07/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 6300-015 | WI | N | Dental Providers | Dentist | 122300000X | 30.023865 | OH | Y | Dental Providers | Dentist |
No ID Information.