Provider Demographics
NPI:1417085135
Name:CHARLES A NARDIELLO, D.M.D.,P.C.
Entity Type:Organization
Organization Name:CHARLES A NARDIELLO, D.M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:NARDIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-591-5637
Mailing Address - Street 1:11200 LEE HWY
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5045
Mailing Address - Country:US
Mailing Address - Phone:703-591-5637
Mailing Address - Fax:703-591-7934
Practice Address - Street 1:11200 LEE HWY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5045
Practice Address - Country:US
Practice Address - Phone:703-591-5637
Practice Address - Fax:703-591-7934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty