MEDICARE: DR. NICHOLAS P FERRI D.D.S.

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	5823-015	WI

General Provider Information

NPI Number	:	1861839409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS P FERRI D.D.S.

Provider Business Mailing Address
First Line	:	5801 WASHINGTON AVE
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53406-4057
Country	:	US
Telephone Number	:	262-884-7700
Fax Number	:	262-637-1454

Provider Business Practice Location Address
First Line	:	5801 WASHINGTON AVE
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53406-4057
Country	:	US
Telephone Number	:	262-884-7700
Fax Number	:	262-637-1454

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

Provider Enumeration Date	:	05/22/2013
Last Update Date	:	05/22/2013

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