Healthcare Provider Details

I. General information

NPI: 1598987810
Provider Name (Legal Business Name): JOEL M. LEVIN, D.D.S. AND JOHN L. HOUGHTALING, D.D.S.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

897 DELAWARE AVE SUITE 200
BUFFALO NY
14209-2007
US

IV. Provider business mailing address

897 DELAWARE AVE SUITE 200
BUFFALO NY
14209-2007
US

V. Phone/Fax

Practice location:
  • Phone: 716-885-0510
  • Fax: 716-885-8092
Mailing address:
  • Phone: 716-885-0510
  • Fax: 716-885-8092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number029731
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number026237
License Number StateNY

VIII. Authorized Official

Name: JOEL M LEVIN
Title or Position: PRESIDENT
Credential: DDS
Phone: 716-885-0510