MEDICARE: LEON DAVID KATZ D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	MD6155	MD

General Provider Information

NPI Number	:	1306013040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEON DAVID KATZ D.D.S.

Provider Business Mailing Address
First Line	:	6210 PARK HEIGHTS AVE
Second Line	:	SUITE 105
City	:	BALTIMORE
State	:	MD
Zip	:	21215-3626
Country	:	US
Telephone Number	:	410-764-7341
Fax Number	:	410-764-2638

Provider Business Practice Location Address
First Line	:	6210 PARK HEIGHTS AVE
Second Line	:	SUITE 105
City	:	BALTIMORE
State	:	MD
Zip	:	21215-3626
Country	:	US
Telephone Number	:	410-764-7341
Fax Number	:	410-764-2638

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2008
Last Update Date	:	05/12/2008

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