MEDICARE: NICOLA TORITTO DMD

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	122300000X	Dentist	019031366	IL

General Provider Information

NPI Number	:	1265959126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLA TORITTO DMD

Provider Business Mailing Address
First Line	:	418 E ROLLINS RD
Second Line	:
City	:	ROUND LAKE BEACH
State	:	IL
Zip	:	60073-1334
Country	:	US
Telephone Number	:	224-814-4466
Fax Number	:	224-814-4291

Provider Business Practice Location Address
First Line	:	418 E ROLLINS RD
Second Line	:
City	:	ROUND LAKE BEACH
State	:	IL
Zip	:	60073-1334
Country	:	US
Telephone Number	:	224-814-4466
Fax Number	:	224-814-4291

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

Provider Enumeration Date	:	08/23/2017
Last Update Date	:	07/21/2022

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