Active NPI
Corinne G Nicolas
- Orthodontics and Dentofacial Orthopedics Dentistry
- Boston, MA
National Provider Identifier
1104716869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- DL100802
- Practice address
- 1 Kneeland St
Boston, MA 02111-1527 - Phone
- (617) 636-6828
- NPI assigned
- Jul 5, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | DL100802 | MA | Primary |
Addresses
Primary practice location
1 Kneeland St
Boston, MA 02111-1527
Mailing address
1 Kneeland St
Boston, MA 02111-1527
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DL100802 | MA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1751673600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753833600000",
"number": "1104716869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 KNEELAND ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021111527"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 KNEELAND ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021111527",
"telephone_number": "617-636-6828"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICOLAS",
"first_name": "CORINNE",
"middle_name": "G",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-07-05",
"last_updated": "2025-07-30",
"certification_date": "2025-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "MA",
"license": "DL100802",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.