MEDICARE: DR. MICHELE A SCALZO - MASTERPOLE D.D.S.

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
1	122300000X	Dentist	051519	NY

General Provider Information

NPI Number	:	1609043850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELE A SCALZO - MASTERPOLE D.D.S.

Provider Business Mailing Address
First Line	:	90 PRESIDENTIAL PLZ # 4B
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13202-2240
Country	:	US
Telephone Number	:	315-464-5256
Fax Number	:	315-464-6524

Provider Business Practice Location Address
First Line	:	90 PRESIDENTIAL PLZ # 4B
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13202-2240
Country	:	US
Telephone Number	:	315-464-5256
Fax Number	:	315-464-6524

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	12/22/2025

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