Healthcare Provider Details

I. General information

NPI: 1053241000
Provider Name (Legal Business Name): MICHELE PATERNO DMD, MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MOUNT LAUREL RD
MOUNT LAUREL NJ
08054-9554
US

IV. Provider business mailing address

4 JERRICK CT
MOUNT LAUREL NJ
08054-9525
US

V. Phone/Fax

Practice location:
  • Phone: 856-722-5664
  • Fax:
Mailing address:
  • Phone: 609-680-1282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number22DIO1753000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: