| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 65 Wolf Rd, Albany, New York |
| Authorized Official Name and Position | Jason Nicoletti (OWNER DOCTOR) |
| Authorized Official Contact | 5184350390 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
65 Wolf Rd Albany NY 12205-2630 Ph: (518) 435-0390 | 65 Wolf Rd Albany NY 12205-2630 Ph: (518) 435-0390 |
| NPI Number | 1770871600 |
|---|---|
| Provider Enumeration Date | 07/12/2011 |
| Last Update Date | 05/10/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770871600 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 052806 (New York) | Primary |
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