Provider Demographics
NPI:1518125178
Name:OFICINA DENTAL DR. RAUL F. CORDERO C.S.P.
Entity Type:Organization
Organization Name:OFICINA DENTAL DR. RAUL F. CORDERO C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:F
Authorized Official - Last Name:CORDERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:787-832-5155
Mailing Address - Street 1:PO BOX 6663
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-6663
Mailing Address - Country:US
Mailing Address - Phone:787-832-5155
Mailing Address - Fax:787-832-5155
Practice Address - Street 1:1118 CALLE JOSE E ARRARAS
Practice Address - Street 2:MAYAGUEZ TERRACE
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-6602
Practice Address - Country:US
Practice Address - Phone:787-832-5155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2051261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental