Provider Demographics
NPI:1891005005
Name:PETER S KATZ DMD
Entity Type:Organization
Organization Name:PETER S KATZ DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:S
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-521-0594
Mailing Address - Street 1:125 LA SALLE ROAD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107
Mailing Address - Country:US
Mailing Address - Phone:860-521-0594
Mailing Address - Fax:860-521-7568
Practice Address - Street 1:125 LA SALLE ROAD
Practice Address - Street 2:SUITE 306
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107
Practice Address - Country:US
Practice Address - Phone:860-521-0594
Practice Address - Fax:860-521-7568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0051511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty