Individual
CORINNE G NICOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 KNEELAND ST, BOSTON, MA 02111-1527
(617) 636-6828
Mailing address
1 KNEELAND ST, BOSTON, MA 02111-1527
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DL100802
MA
Other
Enumeration date
07/05/2025
Last updated
07/30/2025
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