Provider Demographics
NPI:1407056773
Name:OSCAR F CORDERO OF DENTAL CSP
Entity Type:Organization
Organization Name:OSCAR F CORDERO OF DENTAL CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:F
Authorized Official - Last Name:CORDERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:787-882-5205
Mailing Address - Street 1:24 SEVERIANO CUEVOS AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603
Mailing Address - Country:US
Mailing Address - Phone:787-882-5205
Mailing Address - Fax:787-997-5205
Practice Address - Street 1:24 SEVERIANO CUEVOS AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-882-5205
Practice Address - Fax:787-997-5205
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OSCAR F CORDERO OF DENTAL CSP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2097122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty