Healthcare Provider Details

I. General information

NPI: 1841480969
Provider Name (Legal Business Name): SHELDON H. KATZ, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5363 BALBOA BLVD SUITE 233
ENCINO CA
91316-2805
US

IV. Provider business mailing address

5363 BALBOA BLVD SUITE 233
ENCINO CA
91316-2805
US

V. Phone/Fax

Practice location:
  • Phone: 818-788-4424
  • Fax: 818-788-4426
Mailing address:
  • Phone: 818-788-4424
  • Fax: 818-788-4426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD28732
License Number StateCA

VIII. Authorized Official

Name: SHELDON H KATZ
Title or Position: OWNER
Credential: D.D.S.
Phone: 818-788-4424