Provider Demographics
NPI:1609955079
Name:CORDERO, MANUEL A
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:A
Last Name:CORDERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 TALON CT
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-1680
Mailing Address - Country:US
Mailing Address - Phone:856-589-8533
Mailing Address - Fax:856-582-9468
Practice Address - Street 1:2 TALON CT
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-1680
Practice Address - Country:US
Practice Address - Phone:856-589-8533
Practice Address - Fax:856-582-9468
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 143201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice