Healthcare Provider Details

I. General information

NPI: 1215600374
Provider Name (Legal Business Name): NICOLE S CRITSINELIS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

792 BEACON ST
NEWTON CENTRE MA
02459-1977
US

IV. Provider business mailing address

30 GARRISON ST APT 30-112
BOSTON MA
02116-5741
US

V. Phone/Fax

Practice location:
  • Phone: 617-655-9410
  • Fax:
Mailing address:
  • Phone: 954-882-9209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN26266
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number26266
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN10000068
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: