Provider Demographics
NPI:1437226867
Name:CORNEJO DENTAL OFFICE LLP
Entity Type:Organization
Organization Name:CORNEJO DENTAL OFFICE LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RIGOBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNEJO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-481-8906
Mailing Address - Street 1:230 HILTON AVE SUITE 216
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550
Mailing Address - Country:US
Mailing Address - Phone:516-481-8906
Mailing Address - Fax:516-489-5487
Practice Address - Street 1:230 HILTON AVE SUITE 216
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550
Practice Address - Country:US
Practice Address - Phone:516-481-8906
Practice Address - Fax:516-489-5487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0396881122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty