John X Cordoba, DDS MS
Individual provider Active NPI Orthodontics and Dentofacial Orthopedics Dentistry · Debary, FL
NPI 1720115868 · NPPES record last updated Feb 13, 2009
Key facts
- NPI
- 1720115868
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X
- License
- 12482 (FL)
- Practice address
- 90 Fox Ridge CT
Debary, FL 32713-2719 - Phone
- (386) 668-6644
- Fax
- (386) 668-5539
- NPI assigned
- Feb 27, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12482 | FL | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 12482 | FL | Yes |
Addresses
Primary practice location
90 Fox Ridge CT
Debary, FL 32713-2719
Mailing address
90 Fox Ridge CT
Debary, FL 32713-2719
Phone (386) 668-6644
Other providers in Debary, FL
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- Myrna Colon
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- Carlos Enrique Contreras Benitez
- Susan Conyac
- Crown Medical Transport LLC
- Nayaris Cruz
- Antonio Miguel Cubano
- Ashlynn Da Silva
- Jessica Crystal Daigle
All providers in Debary, FL · Orthodontics and Dentofacial Orthopedics Dentistry in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 13, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.