Provider Demographics
NPI:1801280060
Name:LEVINE, CHAIM (DDS)
Entity type:Individual
Prefix:DR
First Name:CHAIM
Middle Name:
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 1:1159 BEACH 9TH ST
Mailing Address - Street 2:APT 1
Mailing Address - City:FAR ROCAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691
Mailing Address - Country:US
Mailing Address - Phone:845-213-0002
Mailing Address - Fax:
Practice Address - Street 1:1159 BEACH 9TH ST
Practice Address - Street 2:APT 1
Practice Address - City:FAR ROCAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691
Practice Address - Country:US
Practice Address - Phone:845-213-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-26
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0586631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice