1194991372 NPI number — NICHOLAS A. NARDUCCI, DMD, PA.

Table of content: (NPI 1194991372)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194991372 NPI number — NICHOLAS A. NARDUCCI, DMD, PA.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NICHOLAS A. NARDUCCI, DMD, PA.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194991372
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3545-1 ST. JOHNS BLUFF RD. S.
Provider Second Line Business Mailing Address:
SUITE 352
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-998-7000
Provider Business Mailing Address Fax Number:
904-998-7702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9995 GATE PKWY N
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32246-4481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-646-2737
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LESS
Authorized Official First Name:
CRYSTAL
Authorized Official Middle Name:
LOVE
Authorized Official Title or Position:
VP OF OPERATIONS
Authorized Official Telephone Number:
904-998-7000

Provider Taxonomy Codes

  • Taxonomy code: 305S00000X , with the licence number:  DN15716 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 305R00000X , with the licence number: DN15716 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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