Provider Demographics
NPI:1790804342
Name:CORDOVA, DAISY G (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAISY
Middle Name:G
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 WAKE FOREST CT
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-1722
Mailing Address - Country:US
Mailing Address - Phone:504-464-0368
Mailing Address - Fax:504-833-5309
Practice Address - Street 1:3301 VETERANS MEMORIAL BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-8447
Practice Address - Country:US
Practice Address - Phone:504-887-6453
Practice Address - Fax:504-833-5309
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA56291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice