Healthcare Provider Details

I. General information

NPI: 1760482947
Provider Name (Legal Business Name): JOEL CORTES D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 S POTOMAC ST
WAYNESBORO PA
17268-2642
US

IV. Provider business mailing address

23706 MALIBU RD
MALIBU CA
90265-4603
US

V. Phone/Fax

Practice location:
  • Phone: 717-762-0879
  • Fax: 717-762-4772
Mailing address:
  • Phone: 310-456-6497
  • Fax: 310-456-5902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number045378
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS036033
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number61901
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: