MEDICARE: DAMARIS ALTAGRACIA CORDERO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0458101	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053427377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAMARIS ALTAGRACIA CORDERO DDS

Provider Business Mailing Address
First Line	:	2925 GRAND CONCOURSE
Second Line	:	SUITE 1A
City	:	BRONX
State	:	NY
Zip	:	10468-1707
Country	:	US
Telephone Number	:	718-329-4111
Fax Number	:	718-329-1614

Provider Business Practice Location Address
First Line	:	2925 GRAND CONCOURSE
Second Line	:	SUITE 1A
City	:	BRONX
State	:	NY
Zip	:	10468-1707
Country	:	US
Telephone Number	:	718-329-4111
Fax Number	:	718-329-1614

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	01/23/2013

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