Nicolette Justine Angioli, DMD
Individual provider Active NPI Dentist · Charlestown, RI
NPI 1376103754 · NPPES record last updated Jun 18, 2019
Key facts
- NPI
- 1376103754
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DEN03458 (RI)
- Practice address
- 4995 S County TRL
Charlestown, RI 02813-3182 - Phone
- (518) 231-9657
- NPI assigned
- Jun 18, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in RI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220211002177 | RI | Order and Referring Only - Dentist |
5799178836 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DEN03458 | RI | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DEN03458 | RI | Yes |
Addresses
Primary practice location
4995 S County TRL
Charlestown, RI 02813-3182
Mailing address
4995 S County TRL
Charlestown, RI 02813-3182
Phone (518) 231-9657
Other providers in Charlestown, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 18, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.