Healthcare Provider Details

I. General information

NPI: 1952405185
Provider Name (Legal Business Name): MARISOL CORDERO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISOL CORDERO-VILLEDA DDS

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MUNRO AVE TRACEN CAPE MAY - DENTAL
CAPE MAY NJ
08204-5000
US

IV. Provider business mailing address

1 MUNRO AVE TRACEN CAPE MAY - DENTAL
CAPE MAY NJ
08204-5000
US

V. Phone/Fax

Practice location:
  • Phone: 609-898-6069
  • Fax: 609-898-6268
Mailing address:
  • Phone: 609-898-6069
  • Fax: 609-898-6268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number048973
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: