MEDICARE: MYRON E. KATZ, DMD, MSD, INC

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	261QD0000X	Dental Clinic/Center	3438	OK

General Provider Information

NPI Number	:	1689613028
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYRON E. KATZ, DMD, MSD, INC

Provider Business Mailing Address
First Line	:	4543 S HARVARD AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-2905
Country	:	US
Telephone Number	:	918-749-6448
Fax Number	:	918-749-7300

Provider Business Practice Location Address
First Line	:	4543 S HARVARD AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-2905
Country	:	US
Telephone Number	:	918-749-6448
Fax Number	:	918-749-7300

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	DR. MYRON E KATZ
Credential	:	D.M.D.
Telephone Number	:	918-749-6448

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	09/29/2008

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