Individual
DR. BRAD A LEVINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
14 MAPLE ST, PORT WASHINGTON, NY 11050-2946
(516) 767-9300
Mailing address
14 MAPLE ST, PORT WASHINGTON, NY 11050-2946
(516) 767-9300
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
040521
NY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
040521
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02254731
—
NY
Enumeration date
11/29/2005
Last updated
09/24/2008
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