Provider Demographics
NPI:1538316385
Name:ALBANDOZ, LOURDES MARHILDA (DMD)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:MARHILDA
Last Name:ALBANDOZ
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 1:10017 NORTHERN BLVD
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-1038
Mailing Address - Country:US
Mailing Address - Phone:718-424-9210
Mailing Address - Fax:718-424-9200
Practice Address - Street 1:10017 NORTHERN BLVD
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368
Practice Address - Country:US
Practice Address - Phone:718-424-9210
Practice Address - Fax:718-424-9200
Is Sole Proprietor?:No
Enumeration Date:2008-08-23
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0541321223G0001X
PR27851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03142110Medicaid