Provider Demographics
NPI:1770611816
Name:KATZ, LELAND DAVID (DDS)
Entity type:Individual
Prefix:
First Name:LELAND
Middle Name:DAVID
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 1:19317 HATTERAS ST
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1117
Mailing Address - Country:US
Mailing Address - Phone:818-881-6170
Mailing Address - Fax:
Practice Address - Street 1:3831 HUGHES AVE STE 610
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-6853
Practice Address - Country:US
Practice Address - Phone:310-390-3675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA193541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice