Provider Demographics
NPI:1083099782
Name:CORDOVA, MONICA (DDS)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 WESTWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-4038
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3004 N CLOSNER BLVD
Practice Address - Street 2:#C
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-7237
Practice Address - Country:US
Practice Address - Phone:956-383-8833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31244122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist