Provider Demographics
NPI:1831249846
Name:LEVINE, TODD R (DDS)
Entity type:Individual
Prefix:DR
First Name:TODD
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 1:5862 SNYDER DR
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-9497
Mailing Address - Country:US
Mailing Address - Phone:716-439-1877
Mailing Address - Fax:716-439-1918
Practice Address - Street 1:5862 SNYDER DRIVE
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094
Practice Address - Country:US
Practice Address - Phone:716-439-1877
Practice Address - Fax:716-439-1918
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2017-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0424911223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02531051Medicaid
NY02531051Medicaid