Provider Demographics
NPI:1144222654
Name:CHAN KATZ, ALEXANDRA L (DDS, MPH)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:L
Last Name:CHAN KATZ
Suffix:
Gender:F
Credentials:DDS, MPH
Other - Prefix:DR
Other - First Name:ALEXANDRA
Other - Middle Name:L
Other - Last Name:CHAN KATZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MPH
Mailing Address - Street 1:14 HEYWARD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-7823
Mailing Address - Country:US
Mailing Address - Phone:718-260-4600
Mailing Address - Fax:914-764-5605
Practice Address - Street 1:58 RUTLEDGE ST
Practice Address - Street 2:ODA PRIMARY HEALTH CARE NETWORK- DIRECTOR DENTAL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-7814
Practice Address - Country:US
Practice Address - Phone:718-260-4620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0478090122300000X
CT008620122300000X
NY0478091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0478090OtherLICENSE
CT008620OtherDENTAL LICENSE STATE
CT008620OtherDENTAL LICENSE STATE