Provider Demographics
NPI:1952643827
Name:SARDELLA, ANDREW V (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:V
Last Name:SARDELLA
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 1:1810 E LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-2408
Mailing Address - Country:US
Mailing Address - Phone:610-383-4100
Mailing Address - Fax:610-383-6256
Practice Address - Street 1:1810 E LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-2408
Practice Address - Country:US
Practice Address - Phone:610-383-4100
Practice Address - Fax:610-383-6256
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029464L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS029464LOtherDENTAL LICENSE #