Provider Demographics
NPI:1497883185
Name:NARDIELLO, CHARLES A (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:NARDIELLO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice