Provider Demographics
NPI:1083814818
Name:KATZ, ELIZABETH IRENE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:IRENE
Last Name:KATZ
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 1:2834 E DEVON ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-5508
Mailing Address - Country:US
Mailing Address - Phone:617-794-3685
Mailing Address - Fax:
Practice Address - Street 1:5504 E 22ND ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-5540
Practice Address - Country:US
Practice Address - Phone:520-462-4241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD073711223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ241148Medicaid