Provider Demographics
NPI:1467894139
Name:MARIANO, NICOLE H (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:H
Last Name:MARIANO
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 1:20 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-2857
Mailing Address - Country:US
Mailing Address - Phone:203-574-1725
Mailing Address - Fax:
Practice Address - Street 1:20 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-2857
Practice Address - Country:US
Practice Address - Phone:203-574-1725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2015-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT108901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice