Provider Demographics
NPI:1063433753
Name:MESSANA, MICHAEL MATTHIEW (DMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MATTHIEW
Last Name:MESSANA
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 1:42 LOCUST LN
Mailing Address - Street 2:
Mailing Address - City:EAST RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07073-1014
Mailing Address - Country:US
Mailing Address - Phone:973-473-4413
Mailing Address - Fax:201-623-2500
Practice Address - Street 1:42 LOCUST LN
Practice Address - Street 2:
Practice Address - City:EAST RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07073-1014
Practice Address - Country:US
Practice Address - Phone:973-473-4413
Practice Address - Fax:201-623-2500
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0185141223X0400X
NY044592-11223X0400X
VA04015115351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics