Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 4915 | NC |
Y | 1223X0400X | Orthodontists | 4915 | NC |
NPI | 1013008218 |
---|---|
Provider Name | Dr. Mark Jay Katz |
First Address | Greensboro, NC 27410-2486 |
Second Address | Greensboro, NC 27410-2486 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 19/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8994777 | (05) | NC |