Provider Demographics
NPI:1518852037
Name:BIFARETTI, NICOLE C (DMD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:C
Last Name:BIFARETTI
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 1:3431 MELISSA CT
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-2265
Mailing Address - Country:US
Mailing Address - Phone:941-286-9764
Mailing Address - Fax:
Practice Address - Street 1:128 MEDWAY RD STE 2&3
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2932
Practice Address - Country:US
Practice Address - Phone:781-325-1091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty