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General NPI Number Information
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NPI Number | 1871862797
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Entity Type | Organization
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Legal Business Name | NICOLE CARNICELLA, D.M.D., P.C.
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Dates
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Enumeration Date | 12/21/2011
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Last Update Date | 12/21/2011
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Provider Practice Location Address
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Address Line | 212 KENLEE DR
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City | BELLEFONTE
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State | PA
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Zip | 16823-2847
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Country | US
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Telephone | 814-355-5254
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Fax | 814-353-0668
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Provider Business Mailing Address
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Address Line | 212 KENLEE DR
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City | BELLEFONTE
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State | PA
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Zip | 16823-2847
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Country | US
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Telephone | 814-355-5254
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Fax | 814-353-0668
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NICOLE MARIE CARNICELLA
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Credential | D.M.D.
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Telephone | 814-355-5252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS035441
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License Number State | PA
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