Provider Demographics
NPI:1497722334
Name:KATZ, RONALD WILLIAM (DMD, PHD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:WILLIAM
Last Name:KATZ
Suffix:
Gender:M
Credentials:DMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 WYATT ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-1544
Mailing Address - Country:US
Mailing Address - Phone:910-425-0395
Mailing Address - Fax:
Practice Address - Street 1:1357 WALTER REED RD STE 101
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4417
Practice Address - Country:US
Practice Address - Phone:910-483-2700
Practice Address - Fax:910-484-3352
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC80771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902189Medicaid