Provider Demographics
NPI:1689631962
Name:NARDUCCI, NICHOLAS A (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:A
Last Name:NARDUCCI
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 1:8209 W. BEAVER STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32220
Mailing Address - Country:US
Mailing Address - Phone:904-781-7782
Mailing Address - Fax:904-998-7702
Practice Address - Street 1:8209 W. BEAVER STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32220
Practice Address - Country:US
Practice Address - Phone:904-781-7782
Practice Address - Fax:904-998-7702
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15716122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist