Provider Demographics
NPI:1508480187
Name:CORTES, JENNY (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:
Last Name:CORTES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 E COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3956
Mailing Address - Country:US
Mailing Address - Phone:954-261-5665
Mailing Address - Fax:
Practice Address - Street 1:1005 E COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-3956
Practice Address - Country:US
Practice Address - Phone:786-257-7189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-30
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN248601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice