Provider Demographics
NPI:1427801000
Name:NICOLOSI, JULIA (DDS)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:
Last Name:NICOLOSI
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 1:140 TERRYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1330
Mailing Address - Country:US
Mailing Address - Phone:631-473-3094
Mailing Address - Fax:631-473-0679
Practice Address - Street 1:140 TERRYVILLE RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1330
Practice Address - Country:US
Practice Address - Phone:631-473-3094
Practice Address - Fax:631-473-0679
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0647061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice