Provider Demographics
NPI:1134216732
Name:KATZ, THEODORE J (DDS)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:J
Last Name:KATZ
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 1:157 GOOSE LN
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2100
Mailing Address - Country:US
Mailing Address - Phone:203-453-4475
Mailing Address - Fax:203-453-3314
Practice Address - Street 1:157 GOOSE LN
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2100
Practice Address - Country:US
Practice Address - Phone:203-453-4475
Practice Address - Fax:203-453-3314
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0086891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice