Provider Demographics
NPI:1912360728
Name:LEVITTOWN DENTAL GROUP PC
Entity Type:Organization
Organization Name:LEVITTOWN DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS-CAMHI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:516-796-6588
Mailing Address - Street 1:64 DIVISION AVE.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-2995
Mailing Address - Country:US
Mailing Address - Phone:516-796-6588
Mailing Address - Fax:516-796-6749
Practice Address - Street 1:64 DIVISION AVE.
Practice Address - Street 2:SUITE 200
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-2995
Practice Address - Country:US
Practice Address - Phone:516-796-6588
Practice Address - Fax:516-796-6749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040726122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03050740Medicaid