Healthcare Provider Details

I. General information

NPI: 1851401194
Provider Name (Legal Business Name): WILLIAM R. LEVIN DMD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 WESTWOOD AVE
RIVERVALE NJ
07675-6336
US

IV. Provider business mailing address

669 WESTWOOD AVE
RIVERVALE NJ
07675-6336
US

V. Phone/Fax

Practice location:
  • Phone: 201-666-1440
  • Fax:
Mailing address:
  • Phone: 201-666-1440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number9104
License Number StateNJ

VIII. Authorized Official

Name: DR. WILLIAM RICHARD LEVIN
Title or Position: PRESIDENT ORTHODONTIST
Credential: DMD
Phone: 201-666-1440