Provider Demographics
NPI:1184731358
Name:DIMAIRA, MICHELE J (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:J
Last Name:DIMAIRA
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 CHANGEBRIDGE RD BLDG C6
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9113
Mailing Address - Country:US
Mailing Address - Phone:973-276-7926
Mailing Address - Fax:
Practice Address - Street 1:170 CHANGEBRIDGE RD BLDG C6
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9113
Practice Address - Country:US
Practice Address - Phone:973-276-7926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ173821223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics