Provider Demographics
NPI:1679955082
Name:CARDARELLI, JUSTIN JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:JAMES
Last Name:CARDARELLI
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 1:165 BEDFORD ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-2758
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:165 BEDFORD ST
Practice Address - Street 2:SUITE #2
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-2758
Practice Address - Country:US
Practice Address - Phone:781-912-3219
Practice Address - Fax:781-221-7839
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856909122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist