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General NPI Number Information
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NPI Number | 1023501210
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Entity Type | Individual
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Provider Name | CARLI SIMONE KATZ DMD
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Gender | Female
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Dates
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Enumeration Date | 06/12/2018
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Last Update Date | 07/24/2020
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Provider Practice Location Address
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Address Line | 2702 BORDEAUX AVE
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City | LA JOLLA
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State | CA
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Zip | 92037-2030
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Country | US
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Telephone | 858-245-6885
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Fax |
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Provider Business Mailing Address
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Address Line | 860 W VALLEY PKWY STE 100
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City | ESCONDIDO
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State | CA
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Zip | 92025-2534
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Country | US
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Telephone | 760-745-1585
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019031719
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 104986
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License Number State | CA
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