Provider Demographics
NPI:1902989973
Name:KATZ, FREDERICK LEE (DDS MSD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:LEE
Last Name:KATZ
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4923 FOXFIRE TRAIL
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562
Mailing Address - Country:US
Mailing Address - Phone:608-836-8629
Mailing Address - Fax:
Practice Address - Street 1:7633 GANSER WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719
Practice Address - Country:US
Practice Address - Phone:608-833-7424
Practice Address - Fax:608-833-9130
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50012421223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics