Provider Demographics
NPI:1578726972
Name:CORDERO PACHECO, DARLEEN M (DMD)
Entity Type:Individual
Prefix:
First Name:DARLEEN
Middle Name:M
Last Name:CORDERO PACHECO
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 1:991 W HUDSON BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-6430
Mailing Address - Country:US
Mailing Address - Phone:704-853-5079
Mailing Address - Fax:704-862-5383
Practice Address - Street 1:2311 ABERDEEN BLVD STE A
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0603
Practice Address - Country:US
Practice Address - Phone:704-853-5449
Practice Address - Fax:704-853-5455
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC150671122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist