Provider Demographics
NPI:1619591047
Name:GARDUNO, JAMES ALEXANDER (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALEXANDER
Last Name:GARDUNO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N EVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-0973
Mailing Address - Country:US
Mailing Address - Phone:509-928-2525
Mailing Address - Fax:
Practice Address - Street 1:420 N EVERGREEN RD STE 600
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-0993
Practice Address - Country:US
Practice Address - Phone:509-928-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61060243122300000X
WADE61060243122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist