Healthcare Provider Details

I. General information

NPI: 1689940744
Provider Name (Legal Business Name): MITCHELL S KATZ DDS AND ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SIMSBURY RD
AVON CT
06001-3763
US

IV. Provider business mailing address

111 SIMSBURY RD
AVON CT
06001-3763
US

V. Phone/Fax

Practice location:
  • Phone: 860-678-1700
  • Fax: 860-677-6994
Mailing address:
  • Phone: 860-678-1700
  • Fax: 860-677-6994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number9132
License Number StateCT

VIII. Authorized Official

Name: DR. MITCHELL S KATZ
Title or Position: OWNER
Credential:
Phone: 860-678-1700