Provider Demographics
NPI:1639303381
Name:KATZ, STEPHANIE L (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:L
Last Name:KATZ
Suffix:
Gender:F
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:OSBORN CORRECTIONAL INSTITUTION
Mailing Address - Street 2:335 BILTON RD
Mailing Address - City:SOMERS
Mailing Address - State:CT
Mailing Address - Zip Code:06071
Mailing Address - Country:US
Mailing Address - Phone:860-814-4748
Mailing Address - Fax:
Practice Address - Street 1:CONNECTICUT VALLEY HOSPITAL 1000 SILVER ST
Practice Address - Street 2:ROSOW DENTAL CLINIC
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457
Practice Address - Country:US
Practice Address - Phone:860-262-6330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-11
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0103871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice