Provider Demographics
NPI:1992788103
Name:KATZ, ALLAN (DDS)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:
Last Name:KATZ
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 1:40 OLD ROUTE 202A
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2848
Mailing Address - Country:US
Mailing Address - Phone:845-354-6619
Mailing Address - Fax:845-354-1893
Practice Address - Street 1:40 OLD ROUTE 202A
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-2848
Practice Address - Country:US
Practice Address - Phone:845-354-6619
Practice Address - Fax:845-354-1893
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311551223G0001X
NJ114501223G0001X
GA83581223G0001X
MD58141223G0001X
VA46551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00683270Medicaid