MEDICARE: NICHOLAS D BARONE DDS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DEN1762	RI
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	13536	MA

General Provider Information

NPI Number	:	1043221476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS D BARONE DDS

Provider Business Mailing Address
First Line	:	1804 MINERAL SPRING AVENUE
Second Line	:
City	:	N PROVIDENCE
State	:	RI
Zip	:	02904-7648
Country	:	US
Telephone Number	:	401-353-1292
Fax Number	:	401-353-5780

Provider Business Practice Location Address
First Line	:	1804 MINERAL SPRING AVENUE
Second Line	:
City	:	N PROVIDENCE
State	:	RI
Zip	:	02904-7648
Country	:	US
Telephone Number	:	401-353-1292
Fax Number	:	401-353-5780

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/08/2007

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