Provider Demographics
NPI:1376698472
Name:CORDERO, JOSE WALDEMAR (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:WALDEMAR
Last Name:CORDERO
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC1 BOX 25709
Mailing Address - Street 2:SAN GERMAN MEDICAL PLAZA #208
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683
Mailing Address - Country:US
Mailing Address - Phone:787-264-3125
Mailing Address - Fax:
Practice Address - Street 1:SAN GERMAN MEDICAL PLAZA #208
Practice Address - Street 2:CARR. #2 KM. 174.0
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-264-3125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15511223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics