MEDICARE: DAVID ANTHONY CORDOBA 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	1223G0001X	General Practice Dentistry	4180	NV

General Provider Information

NPI Number	:	1669575205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ANTHONY CORDOBA DDS

Provider Business Mailing Address
First Line	:	8460 SOUTH EASTON AVE
Second Line	:	SUITE D
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2865
Country	:	US
Telephone Number	:	702-614-4398
Fax Number	:	702-896-3974

Provider Business Practice Location Address
First Line	:	8460 S EASTERN AVE
Second Line	:	SUITE D
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2864
Country	:	US
Telephone Number	:	702-614-4398
Fax Number	:	702-896-3974

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

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	07/26/2007

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