Provider Demographics
NPI:1013176395
Name:DUDLEY KATZ D.D.S.P.C.
Entity Type:Organization
Organization Name:DUDLEY KATZ D.D.S.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUDLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-604-2222
Mailing Address - Street 1:101 SAINT CLAIRE PL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2171
Mailing Address - Country:US
Mailing Address - Phone:410-604-2222
Mailing Address - Fax:
Practice Address - Street 1:101 SAINT CLAIRE PL
Practice Address - Street 2:SUITE 102
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-2171
Practice Address - Country:US
Practice Address - Phone:410-604-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD62061223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD138454600Medicaid