Provider Demographics
NPI:1902086846
Name:LEVINE, RENEE O (DMD)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:O
Last Name:LEVINE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CENTRAL PARK AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-2589
Mailing Address - Country:US
Mailing Address - Phone:914-472-4343
Mailing Address - Fax:914-472-7005
Practice Address - Street 1:800 CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-2589
Practice Address - Country:US
Practice Address - Phone:914-472-4343
Practice Address - Fax:914-472-7005
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21934122300000X
NY054541122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist