Provider Demographics
NPI:1508433483
Name:NOTTOLI, ALLEGRA TAO SHING (DDS)
Entity type:Individual
Prefix:
First Name:ALLEGRA
Middle Name:TAO SHING
Last Name:NOTTOLI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 TREADWELL ST
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-2342
Mailing Address - Country:US
Mailing Address - Phone:203-499-7787
Mailing Address - Fax:
Practice Address - Street 1:23101 SHERMAN PL STE 201
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-2019
Practice Address - Country:US
Practice Address - Phone:818-716-8424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CADDS1113551223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program