Healthcare Provider Details

I. General information

NPI: 1659987402
Provider Name (Legal Business Name): JEFFREY LAWRENCE LEVINE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 W HENRIETTA RD STE 5J
ROCHESTER NY
14623-1360
US

IV. Provider business mailing address

58 INDIANA ST
ROCHESTER NY
14609-7437
US

V. Phone/Fax

Practice location:
  • Phone: 585-292-1270
  • Fax:
Mailing address:
  • Phone: 585-478-8227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number061410
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: