Provider Demographics
NPI:1992764757
Name:MACALUSO, MICHAEL A (DDS, PC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:MACALUSO
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14740 BARRYKNOLL LN
Mailing Address - Street 2:STE 110
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-2884
Mailing Address - Country:US
Mailing Address - Phone:281-870-1488
Mailing Address - Fax:281-870-1482
Practice Address - Street 1:14740 BARRYKNOLL LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-2883
Practice Address - Country:US
Practice Address - Phone:281-870-1488
Practice Address - Fax:281-870-1482
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13198122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist