Provider Demographics
NPI:1194586750
Name:NARCISO, NICOLE (RDH)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:NARCISO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 GLEN RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-1380
Mailing Address - Country:US
Mailing Address - Phone:508-326-1864
Mailing Address - Fax:
Practice Address - Street 1:2 GLEN RD
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:MA
Practice Address - Zip Code:02790-1380
Practice Address - Country:US
Practice Address - Phone:508-326-1864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH89313124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist