Provider Demographics
NPI:1659592921
Name:PATERNO ORTHODONTICS LLC
Entity Type:Organization
Organization Name:PATERNO ORTHODONTICS LLC
Other - Org Name:MICHELE PATERNO DMD MSD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:LLC PRINCIPAL OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATERNO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MSD
Authorized Official - Phone:856-722-5664
Mailing Address - Street 1:501 MT LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:MT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054
Mailing Address - Country:US
Mailing Address - Phone:856-722-5664
Mailing Address - Fax:856-722-5198
Practice Address - Street 1:501 MT LAUREL RD
Practice Address - Street 2:
Practice Address - City:MT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054
Practice Address - Country:US
Practice Address - Phone:856-722-5664
Practice Address - Fax:856-722-5198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI017530001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty