Provider Demographics
NPI:1275651945
Name:KATZ, MICHAEL MONROE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MONROE
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 1:708 SANFORD RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-4038
Mailing Address - Country:US
Mailing Address - Phone:508-675-0561
Mailing Address - Fax:
Practice Address - Street 1:708 SANFORD RD
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:MA
Practice Address - Zip Code:02790-4038
Practice Address - Country:US
Practice Address - Phone:508-675-0561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA128481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY405-1OtherUNITED HEALTHCARE
PA695979OtherUNITED CONCORDIA
RI8652-7OtherBLUE CROSS BLUE SHIELD
MAX10509OtherBLUE CROSS BLUE SHIELD