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General NPI Number Information
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NPI Number | 1609043850
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Entity Type | Individual
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Provider Name | MICHELE A SCALZO - MASTERPOLE D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 90 PRESIDENTIAL PLZ # 4B
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City | SYRACUSE
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State | NY
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Zip | 13202-2240
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Country | US
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Telephone | 315-464-5256
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Fax | 315-464-6524
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Provider Business Mailing Address
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Address Line | 90 PRESIDENTIAL PLZ # 4B
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City | SYRACUSE
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State | NY
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Zip | 13202-2240
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Country | US
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Telephone | 315-464-5256
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Fax | 315-464-6524
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 051519
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License Number State | NY
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