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General NPI Number Information
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NPI Number | 1467710426
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Entity Type | Individual
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Provider Name | MICHAEL JOHN DICARLO D.D.S
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Gender | Male
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Dates
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Enumeration Date | 04/27/2012
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Last Update Date | 04/26/2022
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Provider Practice Location Address
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Address Line | 475 SEAVIEW AVENUE STATEN ISLAND UNIVERSITY HOSPITAL DENTAL DEPT
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City | STATEN ISLAND
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State | NY
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Zip | 10305
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Country | US
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Telephone | 718-226-9877
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Fax |
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Provider Business Mailing Address
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Address Line | 146 STATE ROUTE 34 STE 200
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City | HOLMDEL
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State | NJ
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Zip | 07733-2416
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Country | US
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Telephone | 732-946-4244
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Fax | 732-946-4492
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI02604100
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License Number State | NJ
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