Provider Demographics
NPI:1396427456
Name:FEDORA KATZ DDS MSD PLLC
Entity type:Organization
Organization Name:FEDORA KATZ DDS MSD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GEDALIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-744-1473
Mailing Address - Street 1:10627 19TH AVE SE STE A
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-5147
Mailing Address - Country:US
Mailing Address - Phone:818-744-1473
Mailing Address - Fax:
Practice Address - Street 1:10627 19TH AVE SE STE A
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-5147
Practice Address - Country:US
Practice Address - Phone:818-744-1473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1720513096OtherNPPES