Healthcare Provider Details

I. General information

NPI: 1467603340
Provider Name (Legal Business Name): CLIFTON PK FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

983 RT 146
CLIFTON PARK NY
12065
US

IV. Provider business mailing address

983 RT 146
CLIFTON PARK NY
12065
US

V. Phone/Fax

Practice location:
  • Phone: 518-371-3333
  • Fax:
Mailing address:
  • Phone: 518-371-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number38704
License Number StateNY

VIII. Authorized Official

Name: DR. ANDREW S. LEVINE
Title or Position: OWNER
Credential: DDS
Phone: 518-584-8150