Provider Demographics
NPI:1639192818
Name:CHIOTELLIS, NICHOLAS M (DDS)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:M
Last Name:CHIOTELLIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W 6TH ST
Mailing Address - Street 2:SUITE N
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-6014
Mailing Address - Country:US
Mailing Address - Phone:408-847-7358
Mailing Address - Fax:408-847-2874
Practice Address - Street 1:700 W 6TH ST
Practice Address - Street 2:SUITE N
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-6014
Practice Address - Country:US
Practice Address - Phone:408-847-7358
Practice Address - Fax:408-847-2874
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA410041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice