Healthcare Provider Details

I. General information

NPI: 1801987532
Provider Name (Legal Business Name): NICHOLAS D BARONE DDS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 MINERAL SPRING AVENUE
N PROVIDENCE RI
02904-7648
US

IV. Provider business mailing address

1804 MINERAL SPRING AVENUE
N PROVIDENCE RI
02904-7648
US

V. Phone/Fax

Practice location:
  • Phone: 401-353-1292
  • Fax: 401-353-5780
Mailing address:
  • Phone: 401-353-1292
  • Fax: 401-353-5780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number13536
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDEN1762
License Number StateRI

VIII. Authorized Official

Name: DR. NICHOLAS D BARONE
Title or Position: PRESIDENT ORTHODONTIST
Credential: DDS
Phone: 401-353-1292