Provider Demographics
NPI:1629154620
Name:CORDERO, RAFAEL EDUARDO (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:EDUARDO
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 1:3345 BURNS RD STE 203
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4305
Mailing Address - Country:US
Mailing Address - Phone:561-557-5909
Mailing Address - Fax:561-557-5918
Practice Address - Street 1:3345 BURNS RD
Practice Address - Street 2:STE. # 203
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4324
Practice Address - Country:US
Practice Address - Phone:561-557-5909
Practice Address - Fax:561-557-5918
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL126711223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics