Provider Demographics
NPI:1851462923
Name:CARDARELLI, VENANZIO (DMD)
Entity Type:Individual
Prefix:DR
First Name:VENANZIO
Middle Name:
Last Name:CARDARELLI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:VENANZIO
Other - Middle Name:
Other - Last Name:CARDARELLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:381 WASHINGTON ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-4741
Mailing Address - Country:US
Mailing Address - Phone:781-843-0881
Mailing Address - Fax:781-843-6080
Practice Address - Street 1:381 WASHINGTON ST
Practice Address - Street 2:SUITE 5
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-4741
Practice Address - Country:US
Practice Address - Phone:781-843-0881
Practice Address - Fax:781-843-6080
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA144971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice