Provider Demographics
NPI:1548377278
Name:BERARDINELLI, NELSON V
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:V
Last Name:BERARDINELLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4154 OLD WILLIAM PENN HWY
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668
Mailing Address - Country:US
Mailing Address - Phone:724-733-2122
Mailing Address - Fax:724-733-9804
Practice Address - Street 1:4154 OLD WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668
Practice Address - Country:US
Practice Address - Phone:724-733-2122
Practice Address - Fax:724-733-9804
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021833L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist