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General NPI Number Information
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NPI Number | 1790804342
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Entity Type | Individual
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Provider Name | DAISY G CORDOVA DDS
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Gender | Female
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3301 VETERANS MEMORIAL BLVD SUITE 203
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City | METAIRIE
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State | LA
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Zip | 70002-8447
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Country | US
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Telephone | 504-887-6453
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Fax | 504-833-5309
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Provider Business Mailing Address
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Address Line | 505 WAKE FOREST CT
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City | KENNER
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State | LA
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Zip | 70065-1722
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Country | US
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Telephone | 504-464-0368
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Fax | 504-833-5309
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5629
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License Number State | LA
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