1952405185 NPI number — MARISOL CORDERO DDS

Table of content: MARISOL CORDERO DDS (NPI 1952405185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952405185 NPI number — MARISOL CORDERO DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORDERO
Provider First Name:
MARISOL
Provider Middle Name:
Provider Name Prefix Text:
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:
CORDERO-VILLEDA
Provider Other First Name:
MARISOL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1952405185
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 MUNRO AVE
Provider Second Line Business Mailing Address:
TRACEN CAPE MAY - DENTAL
Provider Business Mailing Address City Name:
CAPE MAY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08204-5000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-898-6069
Provider Business Mailing Address Fax Number:
609-898-6268

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MUNRO AVE
Provider Second Line Business Practice Location Address:
TRACEN CAPE MAY - DENTAL
Provider Business Practice Location Address City Name:
CAPE MAY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08204-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-898-6069
Provider Business Practice Location Address Fax Number:
609-898-6268
Provider Enumeration Date:
09/08/2006

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: 122300000X , with the licence number:  048973 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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