Provider Demographics
NPI:1336120559
Name:CESPEDES, NELFA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:NELFA
Middle Name:
Last Name:CESPEDES
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 1:293 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-5629
Mailing Address - Country:US
Mailing Address - Phone:973-471-0099
Mailing Address - Fax:973-614-1751
Practice Address - Street 1:293 MAIN AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-5629
Practice Address - Country:US
Practice Address - Phone:973-471-0099
Practice Address - Fax:973-614-1751
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ210881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8903808Medicaid
NJ0000114900OtherAMERICHOICE
NJ1646673OtherUNITED CONCORDIA