Healthcare Provider Details

I. General information

NPI: 1801011200
Provider Name (Legal Business Name): MICHAEL SCAGLIONE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SEARS DR
PARAMUS NJ
07652-3515
US

IV. Provider business mailing address

1 SEARS DR
PARAMUS NJ
07652-3515
US

V. Phone/Fax

Practice location:
  • Phone: 201-261-9866
  • Fax: 201-261-9510
Mailing address:
  • Phone: 201-261-9866
  • Fax: 201-261-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3048
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0264105
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: