Provider Demographics
NPI:1073733226
Name:KATZ, MICHAEL JACOB (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JACOB
Last Name:KATZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270-20 UNION TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1534
Mailing Address - Country:US
Mailing Address - Phone:516-795-7500
Mailing Address - Fax:516-795-8102
Practice Address - Street 1:270-20 UNION TURNPIKE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1534
Practice Address - Country:US
Practice Address - Phone:516-742-5100
Practice Address - Fax:516-795-8102
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24518122300000X
NYNY24518122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist