Provider Demographics
NPI:1225170681
Name:KATZ, DUDLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DUDLEY
Middle Name:
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 1:101 ST CLAIRE PLACE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666
Mailing Address - Country:US
Mailing Address - Phone:410-604-2222
Mailing Address - Fax:410-604-6171
Practice Address - Street 1:101 ST CLAIRE PLACE
Practice Address - Street 2:SUITE 102
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666
Practice Address - Country:US
Practice Address - Phone:410-604-2222
Practice Address - Fax:410-604-6171
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD062061223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD138454600Medicaid