Provider Demographics
NPI:1265675565
Name:KATZ, MICHAEL ALLEN (MICHAEL KATZ)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALLEN
Last Name:KATZ
Suffix:
Gender:M
Credentials:MICHAEL KATZ
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:KATZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MICHAEL KATZ DDS
Mailing Address - Street 1:7 CANTERBURY LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1401
Mailing Address - Country:US
Mailing Address - Phone:516-621-6098
Mailing Address - Fax:
Practice Address - Street 1:175 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4532
Practice Address - Country:US
Practice Address - Phone:516-364-6522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics