Provider Demographics
NPI:1538325063
Name:NARDE, JOSEPH A (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:NARDE
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 1:7189 MOON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-3137
Mailing Address - Country:US
Mailing Address - Phone:706-327-3364
Mailing Address - Fax:706-327-1103
Practice Address - Street 1:7189 MOON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-3137
Practice Address - Country:US
Practice Address - Phone:706-327-3364
Practice Address - Fax:706-327-1103
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA112561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000639427CMedicaid