Active NPI
Sixto Rafael Cornejo Zavala, DMD
- Periodontics
- Orlando, FL
National Provider Identifier
1689308678
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- DN27236
- Practice address
- 4732 S Kirkman Rd
Orlando, FL 32811-3643 - Phone
- (407) 292-7373
- Fax
- (407) 992-8858
- NPI assigned
- Jul 14, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | DN27236 | FL | Primary |
Addresses
Primary practice location
4732 S Kirkman Rd
Orlando, FL 32811-3643
Mailing address
600 Technology Park Ste 101
Lake Mary, FL 32746-7122
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN27236 | FL | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1657756800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693440000000",
"number": "1689308678",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 TECHNOLOGY PARK STE 101",
"city": "LAKE MARY",
"state": "FL",
"postal_code": "327467122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4732 S KIRKMAN RD",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328113643",
"telephone_number": "407-292-7373",
"fax_number": "407-992-8858"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORNEJO ZAVALA",
"first_name": "SIXTO",
"middle_name": "RAFAEL",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-07-14",
"last_updated": "2023-08-31",
"certification_date": "2023-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "FL",
"license": "DN27236",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.