Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 031715 | NY |
NPI | 1043405186 |
---|---|
Provider Name | Ming Shih Levine |
First Address | Buffalo, NY 14214 |
Second Address | Buffalo, NY 14214-3001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2007 |
Last Update Date | 12/09/2007 |