MEDICARE: JOSEPH PAUL GIRARDI D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	047043-1	NY

General Provider Information

NPI Number	:	1487620464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH PAUL GIRARDI D.D.S.

Provider Business Mailing Address
First Line	:	1131 COMMERCE PARK DR E
Second Line	:
City	:	WATERTOWN
State	:	NY
Zip	:	13601-2279
Country	:	US
Telephone Number	:	315-788-1070
Fax Number	:	315-785-1039

Provider Business Practice Location Address
First Line	:	1131 COMMERCE PARK DR E
Second Line	:
City	:	WATERTOWN
State	:	NY
Zip	:	13601-2279
Country	:	US
Telephone Number	:	315-788-1070
Fax Number	:	315-785-1039

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	07/08/2007

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