Provider Demographics
NPI:1013008218
Name:KATZ, MARK JAY (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAY
Last Name:KATZ
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 NEW GARDEN RD STE A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2486
Mailing Address - Country:US
Mailing Address - Phone:336-286-5800
Mailing Address - Fax:336-286-5801
Practice Address - Street 1:2018 NEW GARDEN RD STE A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2486
Practice Address - Country:US
Practice Address - Phone:336-286-5800
Practice Address - Fax:336-286-5801
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC49151223X0400X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8994777Medicaid