Provider Demographics
NPI:1982736955
Name:KATZ, MITCHELL S (DDS)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:S
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 1:1811 INDIGO MARKET DR STE 408
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-5906
Mailing Address - Country:US
Mailing Address - Phone:860-214-0751
Mailing Address - Fax:
Practice Address - Street 1:4965 CENTRE POINTE DR # 100
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-6945
Practice Address - Country:US
Practice Address - Phone:843-277-0102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT09132122300000X
SC9298122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist