Provider Demographics
NPI:1225017478
Name:MUSCARELLA, GARY DAMIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:DAMIAN
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 1:6412 OAK HL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-6539
Mailing Address - Country:US
Mailing Address - Phone:505-294-1606
Mailing Address - Fax:
Practice Address - Street 1:8400 OSUNA RD NE
Practice Address - Street 2:SUITE 1D
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2087
Practice Address - Country:US
Practice Address - Phone:505-293-9559
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1181122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist