Provider Demographics
NPI:1952786709
Name:CORDANO, KEVIN WALTER (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:WALTER
Last Name:CORDANO
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 1:950 THARP RD
Mailing Address - Street 2:BLDG 400
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-8344
Mailing Address - Country:US
Mailing Address - Phone:530-671-2750
Mailing Address - Fax:530-671-5468
Practice Address - Street 1:950 THARP RD
Practice Address - Street 2:BLDG 400
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-8344
Practice Address - Country:US
Practice Address - Phone:530-671-2750
Practice Address - Fax:530-671-5468
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64774122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist