Provider Demographics
NPI:1235325820
Name:LEVIN, KONSTANTIN G (DDS)
Entity Type:Individual
Prefix:
First Name:KONSTANTIN
Middle Name:G
Last Name:LEVIN
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 1:7110 21 AVE
Mailing Address - Street 2:APT 4F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204
Mailing Address - Country:US
Mailing Address - Phone:917-257-3945
Mailing Address - Fax:718-436-1342
Practice Address - Street 1:8686 BAY PARKWAY
Practice Address - Street 2:UNIT M2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214
Practice Address - Country:US
Practice Address - Phone:718-714-7000
Practice Address - Fax:718-436-1342
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047174122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist