Provider Demographics
NPI:1134512726
Name:LEVINE, GEORGE (DDS,MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:LEVINE
Suffix:
Gender:M
Credentials:DDS,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 INDIANA ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-7437
Mailing Address - Country:US
Mailing Address - Phone:585-278-7199
Mailing Address - Fax:
Practice Address - Street 1:840 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1288
Practice Address - Country:US
Practice Address - Phone:585-278-7199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-06
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0621091223S0112X
NY308127204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery