Healthcare Provider Details

I. General information

NPI: 1285366674
Provider Name (Legal Business Name): JOSE LUIS CORDOBA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSE LUIS CORDOBA ZUNIGA

II. Dates (important events)

Enumeration Date: 06/26/2022
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 12TH AVE S STE 401
SEATTLE WA
98144-2730
US

IV. Provider business mailing address

1200 12TH AVE S STE 901
SEATTLE WA
98144-2712
US

V. Phone/Fax

Practice location:
  • Phone: 206-548-5850
  • Fax:
Mailing address:
  • Phone: 206-548-3114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE61321055
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE61321055
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: