Provider Demographics
NPI:1306953567
Name:MICHELE J. DIMAIRA, D.M.D., M.S. PA
Entity type:Organization
Organization Name:MICHELE J. DIMAIRA, D.M.D., M.S. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIMAIRA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:973-276-7926
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ173821223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty