Provider Demographics
NPI:1578680674
Name:MICHAEL M. KATZ, D.D.S.,P.C.
Entity Type:Organization
Organization Name:MICHAEL M. KATZ, D.D.S.,P.C.
Other - Org Name:WESTPORT DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:MONROE
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:508-675-0561
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA128481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI8652-7OtherBLUE CROSS BLUE SHIELD
PA695979OtherUNITED CONCORDIA
MAX10509OtherBLUE CROSS BLUE SHEILD
KY405-1OtherUNITED HEALTHCARE