MEDICARE: DR. SHELDON JAY ITZKOWITZ DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	18492	MA

General Provider Information

NPI Number	:	1023125093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHELDON JAY ITZKOWITZ DDS

Provider Business Mailing Address
First Line	:	288 HIGHLAND AVENUE
Second Line	:
City	:	S ATTLEBORO
State	:	MA
Zip	:	02703
Country	:	US
Telephone Number	:	508-761-5007
Fax Number	:	508-761-7840

Provider Business Practice Location Address
First Line	:	288 HIGHLAND AVENUE
Second Line	:
City	:	S ATTLEBORO
State	:	MA
Zip	:	02703
Country	:	US
Telephone Number	:	508-761-5007
Fax Number	:	508-761-7840

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	07/08/2007

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