Provider Demographics
NPI:1083603666
Name:LEVANT, VENIAMIN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:VENIAMIN
Middle Name:M
Last Name:LEVANT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8411 NORTHERN BLVD
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-1531
Mailing Address - Country:US
Mailing Address - Phone:718-424-7100
Mailing Address - Fax:718-424-7898
Practice Address - Street 1:8411 NORTHERN BLVD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1531
Practice Address - Country:US
Practice Address - Phone:718-424-7100
Practice Address - Fax:718-424-7898
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0497811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02348736Medicaid