Provider Demographics
NPI:1164521779
Name:CORDERO, ROSSANA R (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROSSANA
Middle Name:R
Last Name:CORDERO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 MCKEEVER AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-4023
Mailing Address - Country:US
Mailing Address - Phone:510-259-0717
Mailing Address - Fax:510-259-7107
Practice Address - Street 1:1010 MCKEEVER AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4023
Practice Address - Country:US
Practice Address - Phone:510-259-0717
Practice Address - Fax:510-259-7107
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB39621122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist