Provider Demographics
NPI:1114141926
Name:LEVINE, JOAN BETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:BETH
Last Name:LEVINE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E 33RD ST
Mailing Address - Street 2:15P
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9463
Mailing Address - Country:US
Mailing Address - Phone:212-685-1917
Mailing Address - Fax:
Practice Address - Street 1:115 CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-1001
Practice Address - Country:US
Practice Address - Phone:212-766-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038975-11223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01201812Medicaid