Provider Demographics
NPI:1154439255
Name:MUSCARELLA, WAYNE P (DDS)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:P
Last Name:MUSCARELLA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SANDY CT
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1534
Mailing Address - Country:US
Mailing Address - Phone:516-741-0970
Mailing Address - Fax:516-741-0970
Practice Address - Street 1:4 SANDY CT
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1534
Practice Address - Country:US
Practice Address - Phone:516-741-0970
Practice Address - Fax:516-741-0970
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038708122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist