Provider Demographics
NPI:1558586164
Name:MICELI, JOSEPH D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:D
Last Name:MICELI
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 1:106 NOROTON AVE
Mailing Address - Street 2:MIDDLESEX DENTAL GROUP PC
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-5237
Mailing Address - Country:US
Mailing Address - Phone:203-655-9922
Mailing Address - Fax:203-655-9597
Practice Address - Street 1:106 NOROTON AVE
Practice Address - Street 2:MIDDLESEX DENTAL GROUP PC
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-5237
Practice Address - Country:US
Practice Address - Phone:203-655-9922
Practice Address - Fax:203-655-9597
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4887122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT020004887CT01OtherBC BS