Provider Demographics
NPI:1982798716
Name:SHATZ, PETER CLIFFORD (DDS)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:CLIFFORD
Last Name:SHATZ
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 1:3737 UPLAND DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3060
Mailing Address - Country:US
Mailing Address - Phone:678-773-1699
Mailing Address - Fax:
Practice Address - Street 1:3737 UPLAND DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-3060
Practice Address - Country:US
Practice Address - Phone:678-773-1699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD10916GD122300000X
SCDGD10917DS1223P0300X
GADN0113841223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist