Provider Demographics
NPI:1679739072
Name:NICHOLAS FEOLA, DDS, PLLC
Entity type:Organization
Organization Name:NICHOLAS FEOLA, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:FEOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-768-1736
Mailing Address - Street 1:1334 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:WV
Mailing Address - Zip Code:25064-2933
Mailing Address - Country:US
Mailing Address - Phone:304-768-1736
Mailing Address - Fax:304-768-4544
Practice Address - Street 1:1334 OHIO AVE
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-2933
Practice Address - Country:US
Practice Address - Phone:304-768-1736
Practice Address - Fax:304-768-4544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0137104000Medicaid