Healthcare Provider Details

I. General information

NPI: 1235754904
Provider Name (Legal Business Name): DAVID GABRIEL CORDARO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 MOODY PKWY
MOODY AL
35004-3012
US

IV. Provider business mailing address

1124 20TH ST S APT 404
BIRMINGHAM AL
35205-2615
US

V. Phone/Fax

Practice location:
  • Phone: 205-640-1717
  • Fax: 205-640-4902
Mailing address:
  • Phone: 706-836-3202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6760
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6760
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerSTATE OF ALABAMA DENTAL LICENSE NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: