Provider Demographics
NPI:1417109414
Name:KATZ, STEPHEN RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:RICHARD
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 1:27 QUAIL RD
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-3370
Mailing Address - Country:US
Mailing Address - Phone:203-637-5521
Mailing Address - Fax:
Practice Address - Street 1:10 LAKE DR S
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CT
Practice Address - Zip Code:06878-2016
Practice Address - Country:US
Practice Address - Phone:203-637-5521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4221122300000X
NY027578122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist