Provider Demographics
NPI:1124104104
Name:KATZEN, JAN S (DDS)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:S
Last Name:KATZEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 LAUREN HILL CT
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-6513
Mailing Address - Country:US
Mailing Address - Phone:410-206-6150
Mailing Address - Fax:
Practice Address - Street 1:2029 SUFFOLK RD.
Practice Address - Street 2:SUITE A
Practice Address - City:FINKSBURG
Practice Address - State:MD
Practice Address - Zip Code:21048-1630
Practice Address - Country:US
Practice Address - Phone:410-861-8900
Practice Address - Fax:410-861-8445
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD137611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice