MEDICARE: RONALD W KATZ DMD PA

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	8077	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396804308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONALD W KATZ DMD PA

Provider Business Mailing Address
First Line	:	1357 WALTER REED RD
Second Line	:	SUITE 101
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-4415
Country	:	US
Telephone Number	:	910-483-2700
Fax Number	:	910-484-3352

Provider Business Practice Location Address
First Line	:	1357 WALTER REED RD
Second Line	:	SUITE 101
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-4415
Country	:	US
Telephone Number	:	910-483-2700
Fax Number	:	910-484-3352

Authorized Official
Title or Position	:	INSURANCE SUPERVISOR
Name	:	MRS. SHELLEY HOWE
Credential	:
Telephone Number	:	910-483-2700

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	08/22/2020

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