Provider Demographics
NPI:1659002129
Name:SHATZ ORTHODONTICS, PLLC
Entity Type:Organization
Organization Name:SHATZ ORTHODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SHATZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-536-5800
Mailing Address - Street 1:3471 LONG BEACH RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5424
Mailing Address - Country:US
Mailing Address - Phone:516-536-5800
Mailing Address - Fax:516-208-7447
Practice Address - Street 1:3471 LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-5424
Practice Address - Country:US
Practice Address - Phone:516-536-5800
Practice Address - Fax:516-208-7447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY047087OtherDENTAL LICENSE
NYBS7465354OtherDEA