Provider Demographics
NPI:1871797803
Name:SCALIA, MICHAEL (DDS, BA)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:SCALIA
Suffix:
Gender:M
Credentials:DDS, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 FRANKLIN LN APT G
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-1175
Mailing Address - Country:US
Mailing Address - Phone:319-594-1599
Mailing Address - Fax:
Practice Address - Street 1:41 ELM ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7201
Practice Address - Country:US
Practice Address - Phone:973-540-1311
Practice Address - Fax:973-540-0092
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI022373001223P0700X
NY0535081223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics