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General NPI Number Information
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NPI Number | 1417085135
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Entity Type | Organization
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Legal Business Name | CHARLES A NARDIELLO, D.M.D.,P.C.
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11200 LEE HWY
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City | FAIRFAX
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State | VA
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Zip | 22030-5045
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Country | US
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Telephone | 703-591-5637
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Fax | 703-591-7934
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Provider Business Mailing Address
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Address Line | 11200 LEE HWY
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City | FAIRFAX
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State | VA
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Zip | 22030-5045
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Country | US
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Telephone | 703-591-5637
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Fax | 703-591-7934
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES A. NARDIELLO
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Credential | D.M.D.
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Telephone | 703-591-5637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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