Provider Demographics
NPI:1023246337
Name:KATZ, SANDRA D (RDHAP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:D
Last Name:KATZ
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 1/2 S SPALDING DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3609
Mailing Address - Country:US
Mailing Address - Phone:310-291-2879
Mailing Address - Fax:
Practice Address - Street 1:308 1/2 S SPALDING DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3609
Practice Address - Country:US
Practice Address - Phone:310-291-2879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA256124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist