Provider Demographics
NPI:1225139843
Name:NARDOZZA, V STEPHEN (DDS)
Entity Type:Individual
Prefix:
First Name:V
Middle Name:STEPHEN
Last Name:NARDOZZA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:SOLVAY
Mailing Address - State:NY
Mailing Address - Zip Code:13209-1705
Mailing Address - Country:US
Mailing Address - Phone:315-468-1000
Mailing Address - Fax:315-468-1696
Practice Address - Street 1:523 CHARLES AVE
Practice Address - Street 2:
Practice Address - City:SOLVAY
Practice Address - State:NY
Practice Address - Zip Code:13209-1705
Practice Address - Country:US
Practice Address - Phone:315-468-1000
Practice Address - Fax:315-468-1696
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0428791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice