Provider Demographics
NPI:1659538395
Name:SANTOS-CORDERO, MARIBEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIBEL
Middle Name:
Last Name:SANTOS-CORDERO
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 1:7315 MERCHANT CT
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8463
Mailing Address - Country:US
Mailing Address - Phone:941-907-7762
Mailing Address - Fax:941-373-6442
Practice Address - Street 1:7315 MERCHANT CT
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-8463
Practice Address - Country:US
Practice Address - Phone:941-907-7762
Practice Address - Fax:941-373-6442
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 157721223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076468000Medicaid