Provider Demographics
NPI:1609896265
Name:NARDI, PAUL ARNOLD (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ARNOLD
Last Name:NARDI
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 1:275 BICENTENNIAL HWY
Mailing Address - Street 2:SUITE #206
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1900
Mailing Address - Country:US
Mailing Address - Phone:413-426-9632
Mailing Address - Fax:413-426-9634
Practice Address - Street 1:275 BICENTENNIAL HWY
Practice Address - Street 2:SUITE #206
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-1900
Practice Address - Country:US
Practice Address - Phone:413-426-9632
Practice Address - Fax:413-426-9634
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA142681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX07442OtherBLUE CROSS & BLUE SHIELD