Provider Demographics
NPI:1811017643
Name:NARDEA, HENRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:NARDEA
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 1:12 ALVORD ST
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-1152
Mailing Address - Country:US
Mailing Address - Phone:732-859-3353
Mailing Address - Fax:732-222-1149
Practice Address - Street 1:121 HIGHWAY 36
Practice Address - Street 2:#100
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1459
Practice Address - Country:US
Practice Address - Phone:732-222-8516
Practice Address - Fax:732-222-1149
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI014621122300000X
VA0401411236122300000X
OH30.023649122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist