Provider Demographics
NPI:1598257339
Name:GROSSER, LEVI YECHIEL (DMD)
Entity Type:Individual
Prefix:MR
First Name:LEVI
Middle Name:YECHIEL
Last Name:GROSSER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 DONAHUE AVE
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11096-1052
Mailing Address - Country:US
Mailing Address - Phone:516-398-4110
Mailing Address - Fax:
Practice Address - Street 1:390 BERRY ST STE B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-6086
Practice Address - Country:US
Practice Address - Phone:718-218-7210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0606261223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program