Provider Demographics
NPI:1760725063
Name:KATZ, ELLIOTT NATHAN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:NATHAN
Last Name:KATZ
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 45TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-5028
Mailing Address - Country:US
Mailing Address - Phone:419-290-1850
Mailing Address - Fax:
Practice Address - Street 1:3611 1ST ST E STE 530
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-4423
Practice Address - Country:US
Practice Address - Phone:941-746-7460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN217711223X0400X
IL0190297281223G0001X
390200000X
TN108911223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program