Provider Demographics
NPI:1518291301
Name:CORDERO, FABIO G (DDS)
Entity Type:Individual
Prefix:DR
First Name:FABIO
Middle Name:G
Last Name:CORDERO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8114 QUEENS BLVD
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-3757
Mailing Address - Country:US
Mailing Address - Phone:718-533-1515
Mailing Address - Fax:
Practice Address - Street 1:8114 QUEENS BLVD
Practice Address - Street 2:SUITE 1002
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3757
Practice Address - Country:US
Practice Address - Phone:718-533-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041162-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1033227798OtherNPI ORGANIZATION