Organization Name: | MASELLA FAMILY DENTAL, PC |
NPI Number: | 1043685324 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL JAMES MASELLA (OWNER) |
Mailing Address: | 195 Fairfield Ave Suite 3a West Caldwell |
State: | NJ US |
Postal Code: | 070066424 |
Phone Number: | 9732263242 |
Fax Number: | 9732286169 |
NPI Enumeration Date: | 12/11/2015 |
NPI Last Update Date: | 12/11/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 22DI02287800 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |