Provider Demographics
NPI:1952344160
Name:LEVINE, IRA ADAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:ADAM
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 1:111 NORTH CENTRAL PARK AVENUE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530
Mailing Address - Country:US
Mailing Address - Phone:914-997-2775
Mailing Address - Fax:914-997-9394
Practice Address - Street 1:111 NORTH CENTRAL PARK AVENUE
Practice Address - Street 2:SUITE 280
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530
Practice Address - Country:US
Practice Address - Phone:914-997-2775
Practice Address - Fax:914-997-9394
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0428781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice