Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jack Miceli DDS PC

Organization General Practice Dentistry · NPI 1932266566

Jack Miceli DDS PC is a General Practice Dentistry in Staten Island, New York. Licensed in New York. Registered with an NPI since 2007.

Licensed in
NY
In the registry since
2007
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

255 Mason Ave
Staten Island, NY 10305-3416
Phone: (718) 987-6543
Fax: (718) 987-6542
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X · Licence 39067 (NY)

Record details

NPI number1932266566
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationMarine Dental Services
Authorized official Jack Miceli — President · (718) 987-6543
Other names Marine Dental Services
NPI enumeratedJanuary 2, 2007
Last updated in NPPESFebruary 23, 2010
Mailing address255 Mason Ave., Staten Island, NY 10305-3416

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