DR. SHERDON WADE CORDOVA (NPI# 1568594638) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568594638 |
| Entity Type | Individual |
| Full Name | DR. SHERDON WADE CORDOVA |
| Credential | DDS |
| Practice Address |
614 Laurel Dr Saint Joseph IL 61873-9402 |
| Practice Telephone | 2173833289 |
| Practice Fax Number | 2173837071 |
| Mailing Telephone | 2173833289 |
| Mailing Fax Number | 2173837071 |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2011-05-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
019.026964 | IL | Dental Providers |
| Street Address |
614 LAUREL DR |
| City | SAINT JOSEPH |
| State | IL |
| Zip Code | 61873-9402 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497175442 | Athletico Ltd | Physical Therapist | 109 N. Main Street, Saint Joseph, IL 61873 | 2014-04-17 |
| 1225182702 | Alina Paul | Family Medicine | 226 E Lincoln, St Joseph, IL 61873 | 2007-01-22 |
| 1750484036 | Edmund R. Rudnicke II, Prof Corp | Dentist | 302 E Lincoln, St Joseph, IL 61873 | 2006-09-05 |
| 1679676951 | Edmund Robert Rudnicke II | Dentist | 302 E Lincoln St, Saint Joseph, IL 61873 | 2006-09-05 |
| 1265618615 | Jmp Counseling and Tutoring Services, LLC | Counselor | 109 N. Main St., St. Joseph, IL 61873 | 2008-01-16 |
| 1942323282 | Bryan Myles Manion | Counselor | 109 N Main St, St Joseph, IL 61873 | 2007-04-10 |
| 1376635078 | Illini Christian Ministries Inc | Psychologist | 204 N Main St, Suite 203, Saint Joseph, IL 61873 | 2006-09-29 |
| 1558335703 | Troy Dean Branson | Chiropractor | 109 N Main, St Joseph, IL 61873-0028 | 2006-02-15 |
| 1417950387 | St. Joseph Drugs, Inc. | Pharmacist | 204 N. Main St., Saint Joseph, IL 61873-0500 | 2005-05-24 |
| 1285668830 | St. Joseph Drugs, Inc | Pharmacy | 204 N. Main, St. Joseph, IL 61873-0500 | 2006-07-10 |
| Find all providers in zip 61873 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386914554 | John Lyons Porritt | Dentist | 4439 Woodridge Way, Saint Joseph, MI 49085-9623 | 2012-01-05 |
| 1154485613 | Northwest Missouri Oral & Maxillofacial Surgeons | Dentist | 3109 Frederick Ave Ste A, Saint Joseph, MO 64506-3073 | 2006-12-20 |
| 1891731204 | John Marion Kim | Dentist | 3102 Niles Rd, Saint Joseph, MI 49085-8609 | 2006-06-22 |
| 1437144458 | Robert M Crittenden | Dentist | 3109 Frederick Ave, Suite A, Saint Joseph, MO 64506-2911 | 2005-09-15 |
| 1407112600 | Adam Matthias | Dentist | 3109 Frederick Ave, Saint Joseph, MO 64506-2959 | 2012-04-02 |
| 1144537333 | John M Kim Dmd PC | Dentist | 3102 Niles Rd, Saint Joseph, MI 49085-8609 | 2010-09-09 |
| 1245544824 | Lake Michigan Oral & Maxillofacial Surgery Pllc | Dentist | 3950 Hollywood Rd, 290, Saint Joseph, MI 49085-9151 | 2010-08-05 |
| 1427159953 | Robert Charles Paolillo | Dentist | 3904 Beck Rd, Suite 150, Saint Joseph, MO 64506-4952 | 2006-09-26 |
| 1417058926 | Robert C. Paolillo,ddspc | Dentist | 3904 Beck Rd, Suite 150, Saint Joseph, MO 64506-4952 | 2006-09-26 |
| 1487755930 | Roger Kent Smith | Dentist | 3904 Beck Rd, Suite 150, Saint Joseph, MO 64506-4952 | 2006-09-26 |
| Find all providers in SAINT JOSEPH | ||||
| City | SAINT JOSEPH |
| Zip Code | 61873 |
Please comment or provide details below to improve the information on DR. SHERDON WADE CORDOVA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.