Healthcare Provider Details

I. General information

NPI: 1164603197
Provider Name (Legal Business Name): ADAM DAVID SHATZ D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ADAM DAVID SHATZ D.D.S.

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3471 LONG BEACH RD
OCEANSIDE NY
11572-5424
US

IV. Provider business mailing address

3471 LONG BEACH RD
OCEANSIDE NY
11572-5424
US

V. Phone/Fax

Practice location:
  • Phone: 516-536-5800
  • Fax: 516-536-3578
Mailing address:
  • Phone: 516-536-5800
  • Fax: 516-208-7447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN124016
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number11218
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number047087
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: