Provider Demographics
NPI:1245315951
Name:MUSCATO, MICHAEL B (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:MUSCATO
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 1:2229 E MCDOWELL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2448
Mailing Address - Country:US
Mailing Address - Phone:602-275-2020
Mailing Address - Fax:602-275-0521
Practice Address - Street 1:2229 E MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2448
Practice Address - Country:US
Practice Address - Phone:602-275-2020
Practice Address - Fax:602-275-0521
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice