Provider Demographics
NPI:1982930616
Name:REALE, MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:REALE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 DOGWOOD AVE
Mailing Address - Street 2:SUTIE 109
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3409
Mailing Address - Country:US
Mailing Address - Phone:516-483-0800
Mailing Address - Fax:516-538-7358
Practice Address - Street 1:340 DOGWOOD AVE
Practice Address - Street 2:SUTIE 109
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-3409
Practice Address - Country:US
Practice Address - Phone:516-483-0800
Practice Address - Fax:516-538-7358
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-31
Last Update Date:2009-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0453751223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry