Organization
DENTAL AMERICA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FABIO GERARDO CORDERO DDS (PRESIDENT)
(718) 533-1515
Entity
Organization
Contact information
Practice address
81 14 QUEENS BLVD., ELMHURST, NY 11373
(718) 533-1515
(718) 289-6508
Mailing address
8114 QUEENS BLVD, ELMHURST, NY 11373-3757
(718) 533-1515
(718) 289-6508
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
041162
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01435776
—
NY
01
—
9200032
DORAL DENTAL IPA OF NY
NY
Enumeration date
08/25/2006
Last updated
03/26/2008
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