1790804342 NPI number — DR. DAISY G CORDOVA DDS

Table of content: DR. DAISY G CORDOVA DDS (NPI 1790804342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790804342 NPI number — DR. DAISY G CORDOVA DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORDOVA
Provider First Name:
DAISY
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790804342
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 WAKE FOREST CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNER
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70065-1722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-464-0368
Provider Business Mailing Address Fax Number:
504-833-5309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3301 VETERANS MEMORIAL BLVD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70002-8447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-887-6453
Provider Business Practice Location Address Fax Number:
504-833-5309
Provider Enumeration Date:
03/28/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  5629 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)