Provider Demographics
NPI:1407925837
Name:SCUTARI, PASQUALE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:PASQUALE
Middle Name:
Last Name:SCUTARI
Suffix:JR
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 1:516 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1537
Mailing Address - Country:US
Mailing Address - Phone:315-637-4476
Mailing Address - Fax:315-637-1261
Practice Address - Street 1:7334 BUCKLEY RD
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-2657
Practice Address - Country:US
Practice Address - Phone:315-458-8680
Practice Address - Fax:315-458-2786
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045842-11223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01952107Medicaid
NYBB1301Medicare UPIN
NYU71091Medicare ID - Type Unspecified