Healthcare Provider Details

I. General information

NPI: 1760725063
Provider Name (Legal Business Name): ELLIOTT NATHAN KATZ D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 1ST ST E STE 530
BRADENTON FL
34208-4423
US

IV. Provider business mailing address

424 45TH AVE NE
ST PETERSBURG FL
33703-5028
US

V. Phone/Fax

Practice location:
  • Phone: 941-746-7460
  • Fax:
Mailing address:
  • Phone: 419-290-1850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN21771
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: