Provider Demographics
NPI:1629014998
Name:KATZ, PETER S (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:S
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 1:1 PHOENIX MILL LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-1476
Mailing Address - Country:US
Mailing Address - Phone:603-924-9241
Mailing Address - Fax:
Practice Address - Street 1:1 PHOENIX MILL LN
Practice Address - Street 2:SUITE 202
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1476
Practice Address - Country:US
Practice Address - Phone:603-924-9241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH33351223G0001X
MA138871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30303356Medicaid