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NPI Code Detail

MEDICARE: MASELLA FAMILY DENTAL, PC

MEDICARE: MASELLA FAMILY DENTAL, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD0000XDental Clinic/Center22DI02287800NJ

General Provider Information

NPI Number : 1043685324
Entity Type Code : Organization
Provider Name (Legal Business Name) : MASELLA FAMILY DENTAL, PC
Provider Business Mailing Address
First Line : 195 FAIRFIELD AVE
Second Line : SUITE 3A
City : WEST CALDWELL
State : NJ
Zip : 07006-6424
Country : US
Telephone Number : 973-226-3242
Fax Number : 973-228-6169
Provider Business Practice Location Address
First Line : 195 FAIRFIELD AVE
Second Line : SUITE 3A
City : WEST CALDWELL
State : NJ
Zip : 07006-6424
Country : US
Telephone Number : 973-226-3242
Fax Number : 973-228-6169
Authorized Official
Title or Position : OWNER
Name : DR. MICHAEL JAMES MASELLA
Credential : D.M.D.
Telephone Number : 973-226-3242
Provider Enumeration Date : 12/11/2015
Last Update Date : 12/11/2015

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Directions to “MASELLA FAMILY DENTAL, PC ” Practice Location

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