Provider Demographics
NPI:1952405185
Name:CORDERO, MARISOL (DDS)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:CORDERO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARISOL
Other - Middle Name:
Other - Last Name:CORDERO-VILLEDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1 MUNRO AVE
Mailing Address - Street 2:TRACEN CAPE MAY - DENTAL
Mailing Address - City:CAPE MAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08204-5000
Mailing Address - Country:US
Mailing Address - Phone:609-898-6069
Mailing Address - Fax:609-898-6268
Practice Address - Street 1:1 MUNRO AVE
Practice Address - Street 2:TRACEN CAPE MAY - DENTAL
Practice Address - City:CAPE MAY
Practice Address - State:NJ
Practice Address - Zip Code:08204-5000
Practice Address - Country:US
Practice Address - Phone:609-898-6069
Practice Address - Fax:609-898-6268
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048973122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist