Provider Demographics
NPI:1235754904
Name:CORDARO, DAVID GABRIEL (DMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GABRIEL
Last Name:CORDARO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 20TH ST S APT 404
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-2615
Mailing Address - Country:US
Mailing Address - Phone:706-836-3202
Mailing Address - Fax:
Practice Address - Street 1:2323 MOODY PKWY
Practice Address - Street 2:
Practice Address - City:MOODY
Practice Address - State:AL
Practice Address - Zip Code:35004-3012
Practice Address - Country:US
Practice Address - Phone:205-640-1717
Practice Address - Fax:205-640-4902
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL67601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL6760OtherSTATE OF ALABAMA DENTAL LICENSE NUMBER