Provider Demographics
NPI:1023125093
Name:ITZKOWITZ, SHELDON JAY (DDS)
Entity type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:JAY
Last Name:ITZKOWITZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 HIGHLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:S ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703
Mailing Address - Country:US
Mailing Address - Phone:508-761-5007
Mailing Address - Fax:508-761-7840
Practice Address - Street 1:288 HIGHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:S ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703
Practice Address - Country:US
Practice Address - Phone:508-761-5007
Practice Address - Fax:508-761-7840
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA184921223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics