Provider Demographics
NPI:1407898331
Name:LEVINE, FREDERICK R (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:R
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 1:2142 ROSA RD
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-3708
Mailing Address - Country:US
Mailing Address - Phone:518-370-0223
Mailing Address - Fax:518-370-3382
Practice Address - Street 1:2142 ROSA RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-3708
Practice Address - Country:US
Practice Address - Phone:518-370-0223
Practice Address - Fax:518-370-3382
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0330491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice