Provider Demographics
NPI:1992923205
Name:MASELLA, MICHAEL JAMES (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:MASELLA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 FAIRFIELD AVE
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-6424
Mailing Address - Country:US
Mailing Address - Phone:973-226-3242
Mailing Address - Fax:973-228-6169
Practice Address - Street 1:195 FAIRFIELD AVE
Practice Address - Street 2:SUITE 3A
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-6424
Practice Address - Country:US
Practice Address - Phone:973-226-3242
Practice Address - Fax:973-228-6169
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD087430001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJFM0029036OtherDEA NUMBER