Provider Demographics
NPI:1669426169
Name:FIORITTO, NICOLE A (DDS)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:A
Last Name:FIORITTO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11115 CADDIE LN
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-8939
Mailing Address - Country:US
Mailing Address - Phone:440-951-5511
Mailing Address - Fax:440-255-5320
Practice Address - Street 1:6303 CENTER ST
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-2467
Practice Address - Country:US
Practice Address - Phone:440-951-5511
Practice Address - Fax:440-255-5320
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300221821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice