MEDICARE: NICHOLAS OLIVERI DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5160	CT

General Provider Information

NPI Number	:	1013417112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS OLIVERI DMD

Provider Business Mailing Address
First Line	:	37 AIRPORT RD
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06114-2002
Country	:	US
Telephone Number	:	860-296-0374
Fax Number	:	860-296-1971

Provider Business Practice Location Address
First Line	:	37 AIRPORT RD
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06114-2002
Country	:	US
Telephone Number	:	860-296-0374
Fax Number	:	860-296-1971

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2018
Last Update Date	:	02/15/2018

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