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Organization
UNIVERSITY DENTAL FACULTY PRACTICE GROUP
Active
Organization
UNIVERSITY DENTAL FACULTY PRACTICE GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID LEVY DMD,MS (MEDICAL DIRECTOR)
(585) 275-0485
Entity
Organization
Contact information
Practice address
2400 S CLINTON AVE STE H220, ROCHESTER, NY 14618-2689
(585) 341-7177
(585) 475-9265
Mailing address
625 ELMWOOD AVE., BOX 683, ROCHESTER, NY 14620-2913
(585) 758-0969
(585) 475-9265
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
1223P0300X
Periodontics
—
—
1223P0700X
Prosthodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5467
BLUE SHIELD
NY
01
—
5529
BLUE SHIELD
NY
01
—
70078
BLUE SHIELD
NY
01
—
7309
BLUE SHIELD
NY
01
—
7876
BLUE SHIELD
NY
01
—
G0187522590
BLUE CHOICE
NY
Enumeration date
10/24/2006
Last updated
06/22/2022
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