MEDICARE: DR. ALBERT A NATELLI JR. DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	007729	CT
2	122300000X	Dentist	51	SC

General Provider Information

NPI Number	:	1134276207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALBERT A NATELLI JR. DDS

Provider Business Mailing Address
First Line	:	5004 YARROW CT
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29485-8682
Country	:	US
Telephone Number	:	608-919-4962
Fax Number	:

Provider Business Practice Location Address
First Line	:	2060 SAM RITTENBERG BLVD BLDG 6192ND
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-4616
Country	:	US
Telephone Number	:	843-876-9267
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	10/26/2022

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