Provider Demographics
NPI:1740222637
Name:GIOVANARDI, ALESSANDRO (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ALESSANDRO
Middle Name:
Last Name:GIOVANARDI
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 W WASHINGTON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2169
Mailing Address - Country:US
Mailing Address - Phone:517-787-4122
Mailing Address - Fax:517-787-5075
Practice Address - Street 1:306 W WASHINGTON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2169
Practice Address - Country:US
Practice Address - Phone:517-787-4122
Practice Address - Fax:517-787-5075
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010134591223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics