Provider Demographics
NPI:1083739627
Name:LEVIN, BRUCE W (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:W
Last Name:LEVIN
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 1:45 ROCKEFELLER PLZ STE 1870
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10111-1860
Mailing Address - Country:US
Mailing Address - Phone:212-246-9070
Mailing Address - Fax:212-977-6393
Practice Address - Street 1:45 ROCKEFELLER PLZ STE 1870
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10111-1860
Practice Address - Country:US
Practice Address - Phone:212-246-9070
Practice Address - Fax:212-977-6393
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0439031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice