Healthcare Provider Details

I. General information

NPI: 1740222637
Provider Name (Legal Business Name): ALESSANDRO GIOVANARDI D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W WASHINGTON AVE SUITE 101
JACKSON MI
49201-2169
US

IV. Provider business mailing address

306 W WASHINGTON AVE SUITE 101
JACKSON MI
49201-2169
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-4122
  • Fax: 517-787-5075
Mailing address:
  • Phone: 517-787-4122
  • Fax: 517-787-5075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2901013459
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: