Provider Demographics
NPI:1043685324
Name:MASELLA FAMILY DENTAL, PC
Entity Type:Organization
Organization Name:MASELLA FAMILY DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MASELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-226-3242
Mailing Address - Street 1:195 FAIRFIELD AVE
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-6424
Mailing Address - Country:US
Mailing Address - Phone:973-226-3242
Mailing Address - Fax:973-228-6169
Practice Address - Street 1:195 FAIRFIELD AVE
Practice Address - Street 2:SUITE 3A
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-6424
Practice Address - Country:US
Practice Address - Phone:973-226-3242
Practice Address - Fax:973-228-6169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02287800261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental