Provider Demographics
NPI:1164561221
Name:CORDERO, GLORIA B (DMD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:B
Last Name:CORDERO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:GLORIA
Other - Middle Name:D
Other - Last Name:BACON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:454 E CARSON PLAZA DR
Mailing Address - Street 2:SUITE 119
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746
Mailing Address - Country:US
Mailing Address - Phone:310-323-8676
Mailing Address - Fax:
Practice Address - Street 1:454 E CARSON PLAZA DR
Practice Address - Street 2:SUITE 119
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746
Practice Address - Country:US
Practice Address - Phone:310-323-8676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38962122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist