Healthcare Provider Details

I. General information

NPI: 1336235472
Provider Name (Legal Business Name): ANTHONY G GIARDINO D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 S SOUTHEAST BLVD STE 210
SPOKANE WA
99223-4984
US

IV. Provider business mailing address

2700 S SOUTHEAST BLVD STE 210
SPOKANE WA
99223-4984
US

V. Phone/Fax

Practice location:
  • Phone: 509-536-7032
  • Fax: 509-536-7002
Mailing address:
  • Phone: 509-536-7032
  • Fax: 509-536-7002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number7126
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: