Provider Demographics
NPI:1699188599
Name:KATZ, ELIMELECH (DMD)
Entity Type:Individual
Prefix:
First Name:ELIMELECH
Middle Name:
Last Name:KATZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8422 BELLONA LN STE 206
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2057
Mailing Address - Country:US
Mailing Address - Phone:845-709-9382
Mailing Address - Fax:
Practice Address - Street 1:8422 BELLONA LN STE 206
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2057
Practice Address - Country:US
Practice Address - Phone:410-828-8828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0400971223G0001X
MD16187122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice