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General NPI Number Information
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NPI Number | 1013282698
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Entity Type | Organization
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Legal Business Name | KATZ FAMILY DENTAL LLC
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Dates
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Enumeration Date | 03/15/2012
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Last Update Date | 03/15/2012
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Provider Practice Location Address
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Address Line | 125 LASALLE RD SUITE 306
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City | WEST HARTFORD
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State | CT
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Zip | 06107-2322
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Country | US
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Telephone | 860-521-0594
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Fax | 860-521-7568
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Provider Business Mailing Address
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Address Line | 125 LASALLE RD SUITE 306
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City | WEST HARTFORD
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State | CT
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Zip | 06107-2322
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Country | US
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Telephone | 860-521-0594
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Fax | 860-521-7568
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Authorized Official
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Title or Position | OWNER
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Name | PETER S KATZ
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Credential | DMD
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Telephone | 860-521-0594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 005151
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License Number State | CT
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