MEDICARE: DR. NICHOLAS JAMES DRAGONETTE II 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	122300000X	Dentist	RESIDENT	NY

General Provider Information

NPI Number	:	1306491436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS JAMES DRAGONETTE II DDS

Provider Business Mailing Address
First Line	:	475 ASHLAND AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14222-1501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2177 UNION RD
Second Line	:
City	:	WEST SENECA
State	:	NY
Zip	:	14224-1428
Country	:	US
Telephone Number	:	716-668-4646
Fax Number	:

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

Provider Enumeration Date	:	08/06/2019
Last Update Date	:	08/06/2019

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