Provider Demographics
NPI:1033324454
Name:LEBOVITZ, ALLAN (DDS)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:
Last Name:LEBOVITZ
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 1:1490 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3865
Mailing Address - Country:US
Mailing Address - Phone:718-859-6006
Mailing Address - Fax:718-377-3429
Practice Address - Street 1:1490 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3865
Practice Address - Country:US
Practice Address - Phone:718-859-6006
Practice Address - Fax:718-377-3429
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0370551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00730429Medicaid