Healthcare Provider Details

I. General information

NPI: 1659573442
Provider Name (Legal Business Name): CRAIG L LEVINE DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 08/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

387 E MAIN ST SUITE 101
BAY SHORE NY
11706-8413
US

IV. Provider business mailing address

387 E MAIN ST SUITE 101
BAY SHORE NY
11706-8413
US

V. Phone/Fax

Practice location:
  • Phone: 631-665-1325
  • Fax:
Mailing address:
  • Phone: 631-665-1325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CRAIG L LEVINE
Title or Position: ORAL SURGEON
Credential: DDS
Phone: 631-665-1325