Provider Demographics
NPI:1891801965
Name:THOMAS W. CORDRICK, D.D.S., INC.
Entity Type:Organization
Organization Name:THOMAS W. CORDRICK, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CORDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-842-5070
Mailing Address - Street 1:6285 PEARL RD STE 29
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3069
Mailing Address - Country:US
Mailing Address - Phone:440-842-5070
Mailing Address - Fax:440-842-5071
Practice Address - Street 1:6285 PEARL RD STE 29
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3069
Practice Address - Country:US
Practice Address - Phone:440-842-5070
Practice Address - Fax:440-842-5071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13653261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental