Provider Demographics
NPI:1801010582
Name:KATZ, JERALD OWEN (DMD)
Entity type:Individual
Prefix:DR
First Name:JERALD
Middle Name:OWEN
Last Name:KATZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-2716
Mailing Address - Country:US
Mailing Address - Phone:816-235-2138
Mailing Address - Fax:816-235-2157
Practice Address - Street 1:650 E 25TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2716
Practice Address - Country:US
Practice Address - Phone:816-235-2138
Practice Address - Fax:816-235-2157
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0148281223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology