Provider Demographics
NPI:1396725313
Name:NICOLETTE, DENNIS A (DMD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:A
Last Name:NICOLETTE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 COURTYARD OFFICES
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-9374
Mailing Address - Country:US
Mailing Address - Phone:570-743-1140
Mailing Address - Fax:570-743-7252
Practice Address - Street 1:5 COURTYARD OFFICES
Practice Address - Street 2:SUITE 350
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-9374
Practice Address - Country:US
Practice Address - Phone:570-743-1140
Practice Address - Fax:570-743-7252
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029523L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist