Provider Demographics
NPI:1760482947
Name:CORTES, JOEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:CORTES
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 1:23706 MALIBU RD
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4603
Mailing Address - Country:US
Mailing Address - Phone:310-456-6497
Mailing Address - Fax:310-456-5902
Practice Address - Street 1:230 S POTOMAC ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:PA
Practice Address - Zip Code:17268-2642
Practice Address - Country:US
Practice Address - Phone:717-762-0879
Practice Address - Fax:717-762-4772
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045378122300000X
PADS036033122300000X
CA61901122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist