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General NPI Number Information
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NPI Number | 1437226867
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Entity Type | Organization
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Legal Business Name | CORNEJO DENTAL OFFICE LLP
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 230 HILTON AVE SUITE 216
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City | HEMPSTEAD
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State | NY
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Zip | 11550
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Country | US
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Telephone | 516-481-8906
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Fax | 516-489-5487
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Provider Business Mailing Address
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Address Line | 230 HILTON AVE SUITE 216
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City | HEMPSTEAD
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State | NY
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Zip | 11550
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Country | US
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Telephone | 516-481-8906
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Fax | 516-489-5487
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Authorized Official
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Title or Position | PARTNER
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Name | RIGOBERTO CORNEJO
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Credential | DDS
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Telephone | 516-481-8906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0396881
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License Number State | NY
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