Provider Demographics
NPI:1164603197
Name:SHATZ, ADAM DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:DAVID
Last Name:SHATZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ADAM
Other - Middle Name:DAVID
Other - Last Name:SHATZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3471 LONG BEACH ROAD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572
Mailing Address - Country:US
Mailing Address - Phone:516-536-5800
Mailing Address - Fax:516-208-7447
Practice Address - Street 1:2882 LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-3114
Practice Address - Country:US
Practice Address - Phone:516-536-5800
Practice Address - Fax:516-536-3578
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0470871223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics