Provider Demographics
NPI:1659573442
Name:CRAIG L LEVINE DDS PC
Entity Type:Organization
Organization Name:CRAIG L LEVINE DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-665-1325
Mailing Address - Street 1:387 E MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8413
Mailing Address - Country:US
Mailing Address - Phone:631-665-1325
Mailing Address - Fax:
Practice Address - Street 1:387 E MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8413
Practice Address - Country:US
Practice Address - Phone:631-665-1325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD3W081Medicare ID - Type Unspecified