Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 5180 | AZ |
NPI | 1013091529 |
---|---|
Provider Name | Dr. Gregory R Giordano |
First Address | Casa Grande, AZ 85122-2226 |
Second Address | Casa Grande, AZ 85122-2226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 12/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
736481 | (05) | AZ |
AZ0412130 | BCBS PROVIDER NUMBER (01) | AZ |