Provider Demographics
NPI:1447465588
Name:KATZ, CARL (DDS)
Entity type:Individual
Prefix:DR
First Name:CARL
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 1:1641 N MILWAUKEE AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-1350
Mailing Address - Country:US
Mailing Address - Phone:847-367-6360
Mailing Address - Fax:847-367-8627
Practice Address - Street 1:1641 N MILWAUKEE AVE
Practice Address - Street 2:STE 3
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1350
Practice Address - Country:US
Practice Address - Phone:847-367-6360
Practice Address - Fax:847-367-8627
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL01900164391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice