Provider Demographics
NPI:1063505089
Name:GIAMBRONE, PHILLIP M (DDS)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:M
Last Name:GIAMBRONE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 HIGHWAY 59 SUITE F
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535
Mailing Address - Country:US
Mailing Address - Phone:251-943-5632
Mailing Address - Fax:251-943-5636
Practice Address - Street 1:7801 HIGHWAY 59 SUITE F
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535
Practice Address - Country:US
Practice Address - Phone:251-943-5632
Practice Address - Fax:251-943-5636
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice