1598987810 NPI number — JOEL M. LEVIN, D.D.S. AND JOHN L. HOUGHTALING, D.D.S.,P.C.

Table of content: (NPI 1598987810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598987810 NPI number — JOEL M. LEVIN, D.D.S. AND JOHN L. HOUGHTALING, D.D.S.,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOEL M. LEVIN, D.D.S. AND JOHN L. HOUGHTALING, D.D.S.,P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598987810
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
897 DELAWARE AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14209-2007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-885-0510
Provider Business Mailing Address Fax Number:
716-885-8092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
897 DELAWARE AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14209-2007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-885-0510
Provider Business Practice Location Address Fax Number:
716-885-8092
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEVIN
Authorized Official First Name:
JOEL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
716-885-0510

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  029731 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0221X , with the licence number: 026237 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00628428 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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