Healthcare Provider Details

I. General information

NPI: 1598257339
Provider Name (Legal Business Name): LEVI YECHIEL GROSSER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 BERRY ST STE B
BROOKLYN NY
11249-6086
US

IV. Provider business mailing address

188 DONAHUE AVE
INWOOD NY
11096-1052
US

V. Phone/Fax

Practice location:
  • Phone: 718-218-7210
  • Fax:
Mailing address:
  • Phone: 516-398-4110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number060626
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: