Provider Demographics
NPI:1336632058
Name:KATZ, ELA GOZLAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELA
Middle Name:GOZLAN
Last Name:KATZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ELA
Other - Middle Name:
Other - Last Name:GOZLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:13704 NW 12TH CT
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2355
Mailing Address - Country:US
Mailing Address - Phone:954-226-2616
Mailing Address - Fax:
Practice Address - Street 1:6820 BIRD ROAD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155
Practice Address - Country:US
Practice Address - Phone:864-768-7117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN234181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice