Charles Cordova Jr., D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4398 Issued in NV

Practice address

2399 Wingfield Hills Rd Ste 130
Sparks, NV 89436-7208

Phone

(775) 624-9963

NPI assigned

Oct 5, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467158400000",
    "number": "1801084678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2399 WINGFIELD HILLS RD STE 130",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "894367208",
            "telephone_number": "775-624-9963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2399 WINGFIELD HILLS RD STE 130",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "894367208",
            "telephone_number": "775-624-9963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORDOVA",
        "first_name": "CHARLES",
        "name_suffix": "Jr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-05",
        "last_updated": "2016-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NV",
            "license": "4398",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Cooper, RN
• Angel Copado-Hernandez
• Austin Cope, DMD
• Skylar Corbitt
• Jennifer Nallely Cordova-Gonzalez
• Miranda Rene Corella
• Zoe Nichole Corkill, APRN
• Kayla Corkrum
• Denise Lynn Cornell, APN
• Elizabeth Corona, M.S.

• General Practice Dentistry in Sparks, NV
• Providers in Sparks, NV by specialty
• General Practice Dentistry in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.