Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | ST-000365 | AL |
NPI | 1578123980 |
---|---|
Provider Name | Dr. Jordan Gigliotti |
First Address | Birmingham, AL 35255-5310 |
Second Address | Birmingham, AL 35233-2110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2019 |
Last Update Date | 28/06/2019 |