Provider Demographics
NPI:1063593358
Name:JORGE O CORDOVA INC
Entity type:Organization
Organization Name:JORGE O CORDOVA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:O
Authorized Official - Last Name:CORDOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-627-2121
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI-196301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty