Healthcare Provider Details

I. General information

NPI: 1750480463
Provider Name (Legal Business Name): CONCETTA FRANCES MACELI D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 ROUTE 25A SUITE E - 1
SHOREHAM NY
11786-1389
US

IV. Provider business mailing address

45 ROUTE 25A SUITE E - 1
SHOREHAM NY
11786-1389
US

V. Phone/Fax

Practice location:
  • Phone: 631-744-6200
  • Fax: 631-744-6387
Mailing address:
  • Phone: 631-744-6200
  • Fax: 631-744-6387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number41478
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: