Provider Demographics
NPI:1194872556
Name:JOSEFA ALTAGRACIA PARRA LEVIN DENTISTRY PC
Entity type:Organization
Organization Name:JOSEFA ALTAGRACIA PARRA LEVIN DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEFA
Authorized Official - Middle Name:ALTAGRACIA
Authorized Official - Last Name:PARRA LEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-384-4009
Mailing Address - Street 1:648 D GRAND ST
Mailing Address - Street 2:
Mailing Address - City:BKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211
Mailing Address - Country:US
Mailing Address - Phone:718-384-4009
Mailing Address - Fax:718-384-4009
Practice Address - Street 1:648 D GRAND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211
Practice Address - Country:US
Practice Address - Phone:718-384-4009
Practice Address - Fax:718-384-4009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0426251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01229643Medicaid