Provider Demographics
NPI:1164561387
Name:GASTALDI, MICHAEL JOSEPH (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:GASTALDI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:JOSEPH
Other - Last Name:GASTALDI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:86 MCCLEAN AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4612
Mailing Address - Country:US
Mailing Address - Phone:718-816-6686
Mailing Address - Fax:718-720-4966
Practice Address - Street 1:86 MCCLEAN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4612
Practice Address - Country:US
Practice Address - Phone:718-816-6686
Practice Address - Fax:718-720-4966
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042127122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist