Provider Demographics
NPI:1073621207
Name:LEVATINO, WILLIAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:LEVATINO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 JACKSON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-1447
Mailing Address - Country:US
Mailing Address - Phone:973-839-4122
Mailing Address - Fax:973-839-3126
Practice Address - Street 1:22 JACKSON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1447
Practice Address - Country:US
Practice Address - Phone:973-839-4122
Practice Address - Fax:973-839-3126
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ109301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJAL7167150OtherDEA REGISTRATION #