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General NPI Number Information
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NPI Number | 1306929013
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Entity Type | Organization
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Legal Business Name | UNIVERSITY DENTAL FACULTY PRACTICE GROUP
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 2400 S CLINTON AVE STE H220
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City | ROCHESTER
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State | NY
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Zip | 14618-2689
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Country | US
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Telephone | 585-341-7177
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Fax | 585-475-9265
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Provider Business Mailing Address
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Address Line | 625 ELMWOOD AVE., BOX 683
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City | ROCHESTER
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State | NY
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Zip | 14620-2913
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Country | US
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Telephone | 585-758-0969
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Fax | 585-475-9265
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DAVID LEVY
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Credential | DMD,MS
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Telephone | 585-275-0485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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