Healthcare Provider Details

I. General information

NPI: 1114287125
Provider Name (Legal Business Name): NICHOLAS PAUL BARONE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 MINERAL SPRING AVE
NORTH PROVIDENCE RI
02904-7648
US

IV. Provider business mailing address

1804 MINERAL SPRING AVE
NORTH 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 NumberDN1855904
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDEN03143
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: