MEDICARE: DR. NICHOLAS PAUL BARONE D.M.D.

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	DN1855904	MA
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DEN03143	RI

General Provider Information

NPI Number	:	1114287125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS PAUL BARONE D.M.D.

Provider Business Mailing Address
First Line	:	1804 MINERAL SPRING AVE
Second Line	:
City	:	NORTH 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 AVE
Second Line	:
City	:	NORTH 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	:	05/23/2012
Last Update Date	:	05/23/2012

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