Provider Demographics
NPI:1376103754
Name:ANGIOLI, NICOLETTE JUSTINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLETTE
Middle Name:JUSTINE
Last Name:ANGIOLI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4995 S COUNTY TRL
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02813-3182
Mailing Address - Country:US
Mailing Address - Phone:518-231-9657
Mailing Address - Fax:
Practice Address - Street 1:4995 S COUNTY TRL
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02813-3182
Practice Address - Country:US
Practice Address - Phone:518-231-9657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN03458122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist