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NPI Code Detail

MEDICARE: DR. PHIL M CORDER D.D.S.

MEDICARE: DR. PHIL M CORDER D.D.S.
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
11223P0221XPediatric Dentistry2397LA

Other Identifiers

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

General Provider Information

NPI Number : 1871638130
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PHIL M CORDER D.D.S.
Provider Business Mailing Address
First Line : 2204 POINT DR
Second Line :
City : MONROE
State : LA
Zip : 71201-2870
Country : US
Telephone Number : 318-387-6905
Fax Number :
Provider Business Practice Location Address
First Line : 117 PROFESSIONAL DR
Second Line :
City : WEST MONROE
State : LA
Zip : 71291-5331
Country : US
Telephone Number : 318-387-8504
Fax Number : 318-387-4757
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2007
Last Update Date : 07/08/2007

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