Provider Demographics
NPI:1548341886
Name:CORDOVA, JORGE O (DMD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:O
Last Name:CORDOVA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 US HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-3826
Mailing Address - Country:US
Mailing Address - Phone:973-627-2121
Mailing Address - Fax:973-627-2088
Practice Address - Street 1:272 US HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-3826
Practice Address - Country:US
Practice Address - Phone:973-627-2121
Practice Address - Fax:973-627-2088
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI-196301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice