Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1851458483 Individual Practitioner Male Practitioner

Dr. Jack Miceli , DDS

Dentist - General Practice • Staten Island, NY

Professional Overview & Biography Verified Profile Summary

Dr. Jack Miceli, DDS is a registered healthcare professional specializing in Dentist - General Practice in Staten Island, NY. Practice services are available at 255 MASON AVE. under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

255 Mason Ave.

Staten Island, NY 103053416

Telephone 7189876543
Fax 7189876542
Associated Practice Facility / Clinic
🏢 Jack Miceli Dds Pc Facility NPI 1932266566

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Staten Island, NY

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 47.0 Yrs
State Avg: 21.2 Yrs
Regional Practice Density
186 Specialists

Practicing in Staten Island, NY (8411 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License NY 39067

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
02241885 (NY)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

4 Associated Practitioners
Dr. Christen Carute , DDS

Dentist - General Practice

NPI 1043691306

Doctor of Dental Surgery

Dr. Vincent Augello , DDS

Dentist - General Practice

NPI 1396802922

Doctor of Dental Surgery

Dr. John Foppiani , DDS

Dentist - Periodontics

NPI 1871650408

Doctor of Dental Surgery

Dr. Michael Reilly , DDS

Dentist - Orthodontics and Dentofacial Orthopedics

NPI 1942367578

Doctor of Dental Surgery

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active February 23, 2010

NPI status registered as active in NPPES database

📍
Updated Practice Location February 23, 2010

Registered at 255 MASON AVE., STATEN ISLAND, NY 103053416 (Tel: 7189876543)

📍
Updated Business Mailing Address February 23, 2010

Registered at 255 MASON AVE., STATEN ISLAND, NY 103053416 (Tel: 7189876543)

👤
Provider Name / Credentials Updated February 23, 2010

Recorded as JACK MICELI, DDS

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) February 23, 2010

Dentist (License #39067 in NY)

🟢
Initial NPI Registration & Enumeration January 02, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1851458483
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: January 02, 2007
Last Update: February 23, 2010
Sole Proprietor: No

Mailing Address

255 Mason Ave.

Staten Island, NY 103053416

Phone: 7189876543

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.