Provider Demographics
NPI:1467665182
Name:KATZ, SHERWIN DOUGLAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHERWIN
Middle Name:DOUGLAS
Last Name:KATZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 BACONSFIELD DR
Mailing Address - Street 2:103
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-1442
Mailing Address - Country:US
Mailing Address - Phone:478-743-3023
Mailing Address - Fax:478-742-5509
Practice Address - Street 1:780 BACONSFIELD DR
Practice Address - Street 2:103
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31211-1442
Practice Address - Country:US
Practice Address - Phone:478-743-3023
Practice Address - Fax:478-742-5509
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA91731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice