Provider Demographics
NPI:1669558649
Name:TREJO, CORNELIA C (D D S)
Entity type:Individual
Prefix:DR
First Name:CORNELIA
Middle Name:C
Last Name:TREJO
Suffix:
Gender:F
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 C WEST LANE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-4944
Mailing Address - Country:US
Mailing Address - Phone:713-622-5139
Mailing Address - Fax:
Practice Address - Street 1:2600 S GESSNER RD
Practice Address - Street 2:SUITE 304
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-3200
Practice Address - Country:US
Practice Address - Phone:713-785-9599
Practice Address - Fax:713-785-1191
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX179541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice