Provider Demographics
NPI:1871585463
Name:SIGNORELLI, MICHAEL SIGNORELLI (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SIGNORELLI
Last Name:SIGNORELLI
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 3865
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09126
Mailing Address - Country:DE
Mailing Address - Phone:004-965-6169
Mailing Address - Fax:3593
Practice Address - Street 1:UNIT 3865
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09126
Practice Address - Country:DE
Practice Address - Phone:004-965-6169
Practice Address - Fax:3593
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV30331223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics