Provider Demographics
NPI:1215600374
Name:CRITSINELIS, NICOLE S (DMD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:S
Last Name:CRITSINELIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 GARRISON ST APT 30-112
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-5741
Mailing Address - Country:US
Mailing Address - Phone:954-882-9209
Mailing Address - Fax:
Practice Address - Street 1:792 BEACON ST
Practice Address - Street 2:
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459-1977
Practice Address - Country:US
Practice Address - Phone:617-655-9410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN262661223P0221X
FL262661223G0001X
MADN100000681223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice