Provider Demographics
NPI:1396807160
Name:NARDECCHIA, ANDREW (DDS)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:NARDECCHIA
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 1:889 MAIN COURT
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623
Mailing Address - Country:US
Mailing Address - Phone:970-963-1616
Mailing Address - Fax:844-602-4638
Practice Address - Street 1:889 MAIN CT
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-1851
Practice Address - Country:US
Practice Address - Phone:970-963-1616
Practice Address - Fax:844-602-4638
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO89401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice