MEDICARE: LELAND 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	19354	CA

General Provider Information

NPI Number	:	1770611816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LELAND DAVID KATZ D.D.S.

Provider Business Mailing Address
First Line	:	19317 HATTERAS ST
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91356-1117
Country	:	US
Telephone Number	:	818-881-6170
Fax Number	:

Provider Business Practice Location Address
First Line	:	3831 HUGHES AVE STE 610
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-6853
Country	:	US
Telephone Number	:	310-390-3675
Fax Number	:

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	12/07/2010

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