Provider Demographics
NPI:1134276207
Name:NATELLI, ALBERT A JR (DDS)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:A
Last Name:NATELLI
Suffix:JR
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 1:5004 YARROW CT
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8682
Mailing Address - Country:US
Mailing Address - Phone:608-919-4962
Mailing Address - Fax:
Practice Address - Street 1:2060 SAM RITTENBERG BLVD BLDG 6192ND
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4616
Practice Address - Country:US
Practice Address - Phone:843-876-9267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0077291223G0001X
SC51122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice