Provider Demographics
NPI:1336278878
Name:MASCOLO, RAYMOND ALFRED (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:ALFRED
Last Name:MASCOLO
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 1:240 CLAY PITTS RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-3427
Mailing Address - Country:US
Mailing Address - Phone:631-368-8617
Mailing Address - Fax:631-368-8621
Practice Address - Street 1:240 CLAY PITTS RD
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-3427
Practice Address - Country:US
Practice Address - Phone:631-368-8617
Practice Address - Fax:631-368-8621
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35363122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist