Provider Demographics
NPI:1356369599
Name:CARNICELLA, NICOLE MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MARIE
Last Name:CARNICELLA
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 1:212 KENLEE DRIVE
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 DRIVE
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0357431223G0001X
PADS0354411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice