Jack Miceli Dds Pc is a Dental Clinic in Staten Island, New York. This organization is also known as sub part of Marine Dental Services. It is located at 255 Mason Ave., Staten Island, NY and its contact number is 718-987-6543. The authorized person for Jack Miceli Dds Pc is Mr. Jack Miceli
who is President of the clinic and their contact number is 718-987-6543. The primary license number for Jack Miceli Dds Pc is 39067 (General Practice) in New York.
Jack Miceli Dds Pc Clinic caters to patients of all ages for their dental care needs. Dentists at the clinic are responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
Complete Clinic Profile:
Jack Miceli Dds Pc Clinic speciality, address, contact phone number and fax are as below.
Patients can call on the below given phone number for appointments.
| Name: | Jack Miceli Dds Pc |
| Specialization: | General Practice Dentistry |
| Clinic Address: | 255 Mason Ave., Staten Island,
New York, 10305-3416 |
| Phone: | 718-987-6543 |
| Fax: | 718-987-6542 |
Authorized/Official Person Profile:
Officially authorized person to contact for any management issues or complaints for this clinic are as below. Person's position and contact details are also mentioned below.
| Name: | Mr. Jack Miceli |
| Position: | President |
| Contact Number: | 718-987-6543 |
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details for Jack Miceli Dds Pc clinic are as mentioned below.
| NPI Number: | 1932266566 |
| Parent Organization: | Marine Dental Services |
| NPI Enumeration Date: | 02 Jan, 2007 |
| NPI Last Update On: | 23 Feb, 2010 |
Medical Licenses:
Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Jack Miceli Dds Pc are as mentioned below.
| Specialization | License Number | State | Status | |
| General Practice | 39067 | New York | Primary | |
Other Medical Identifiers:
Other legacy medical identifiers of the clinic such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
| Identifier | Type | State | Issuer |
| 02353280 | Medicaid | New York | |
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | Jack Miceli Dds Pc
255 Mason Ave.,
Staten Island, New York |
| Zip: | 10305-3416 |
| Phone Number: | 718-987-6543 |
| Fax Number: | 718-987-6542 |
Patients can reach Jack Miceli Dds Pc at
255 Mason Ave., Staten Island, New York or can
call to book an appointment on 718-987-6543.
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**Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on
08 December, 2025.