Provider Demographics
NPI:1588853592
Name:DAVID W. CORDES, D.M.D.,M.D.S.,P.C.
Entity Type:Organization
Organization Name:DAVID W. CORDES, D.M.D.,M.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:E
Authorized Official - Last Name:WYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CDPMA
Authorized Official - Phone:413-562-8100
Mailing Address - Street 1:82 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-2958
Mailing Address - Country:US
Mailing Address - Phone:413-562-8100
Mailing Address - Fax:
Practice Address - Street 1:82 BROAD ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-2958
Practice Address - Country:US
Practice Address - Phone:413-562-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA190431223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty