Healthcare Provider Details

I. General information

NPI: 1265577498
Provider Name (Legal Business Name): CARBONDALE FAMILY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

889 MAIN CT
CARBONDALE CO
81623-1851
US

IV. Provider business mailing address

889 MAIN CT
CARBONDALE CO
81623-1851
US

V. Phone/Fax

Practice location:
  • Phone: 970-963-1616
  • Fax:
Mailing address:
  • Phone: 970-963-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW NARDECCHIA
Title or Position: OWNER
Credential: DDS
Phone: 970-963-1616