Healthcare Provider Details

I. General information

NPI: 1417185471
Provider Name (Legal Business Name): ROSS KATKOWSKI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 08/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1092 MADISON AVE
ALBANY NY
12208
US

IV. Provider business mailing address

1092 MADISON AVE
ALBANY NY
12208
US

V. Phone/Fax

Practice location:
  • Phone: 518-525-1757
  • Fax: 518-525-5171
Mailing address:
  • Phone: 518-525-1757
  • Fax: 518-525-5171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number055101
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: