Healthcare Provider Details

I. General information

NPI: 1659002129
Provider Name (Legal Business Name): SHATZ ORTHODONTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 03/07/2023
Certification Date: 06/23/2022
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: 516-208-7447
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 Number
License Number State

VIII. Authorized Official

Name: DR. ADAM DAVID SHATZ
Title or Position: OWNER
Credential: DDS
Phone: 516-536-5800