Provider Demographics
NPI:1306992649
Name:GIORDANO, JAMES ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:GIORDANO
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 1:6150 GREENFIELD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-6003
Mailing Address - Country:US
Mailing Address - Phone:313-945-0750
Mailing Address - Fax:313-945-0779
Practice Address - Street 1:6150 GREENFIELD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-6003
Practice Address - Country:US
Practice Address - Phone:313-945-0750
Practice Address - Fax:313-945-0779
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901013148122300000X
MI290101314813650221223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901013148OtherDENTIST LICENSE
MI29010131481365022OtherPERIODONTIST