Provider Demographics
NPI:1871862797
Name:NICOLE CARNICELLA, D.M.D., P.C.
Entity Type:Organization
Organization Name:NICOLE CARNICELLA, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CARNICELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:814-355-5252
Mailing Address - Street 1:212 KENLEE DR
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-2847
Mailing Address - Country:US
Mailing Address - Phone:814-355-5254
Mailing Address - Fax:814-353-0668
Practice Address - Street 1:212 KENLEE DR
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-2847
Practice Address - Country:US
Practice Address - Phone:814-355-5254
Practice Address - Fax:814-353-0668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0354411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty