Provider Demographics
NPI:1669754578
Name:CORDOVA-PENA, NORIS (DDS)
Entity type:Individual
Prefix:
First Name:NORIS
Middle Name:
Last Name:CORDOVA-PENA
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 1:495 BRICKELL AVE
Mailing Address - Street 2:APT 5402
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131
Mailing Address - Country:US
Mailing Address - Phone:786-427-3722
Mailing Address - Fax:
Practice Address - Street 1:495 BRICKELL AVE
Practice Address - Street 2:APT 5402
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-2769
Practice Address - Country:US
Practice Address - Phone:786-427-3722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19504122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist