Provider Demographics
NPI:1376620948
Name:LEVINE, SAMUEL SAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:SAUL
Last Name:LEVINE
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 1:166 BUNN DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-2800
Mailing Address - Country:US
Mailing Address - Phone:609-924-1621
Mailing Address - Fax:609-924-6291
Practice Address - Street 1:166 BUNN DR
Practice Address - Street 2:SUITE 103
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2800
Practice Address - Country:US
Practice Address - Phone:609-924-1621
Practice Address - Fax:609-924-6291
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI138581223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU01372Medicare UPIN
NJ520818CJYMedicare ID - Type Unspecified