Provider Demographics
NPI:1316189012
Name:KATZ, JEROME A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:A
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 1:304 FENIMORE RD
Mailing Address - Street 2:6A
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-2521
Mailing Address - Country:US
Mailing Address - Phone:914-698-2108
Mailing Address - Fax:
Practice Address - Street 1:304 FENIMORE RD
Practice Address - Street 2:6A
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-2521
Practice Address - Country:US
Practice Address - Phone:914-698-2108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY21100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist