Provider Demographics
NPI:1750173944
Name:MOTA DE CEDANO, GLADYS N
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:N
Last Name:MOTA DE CEDANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 NECK LN UNIT 320
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-3437
Mailing Address - Country:US
Mailing Address - Phone:347-789-0263
Mailing Address - Fax:347-789-0263
Practice Address - Street 1:1023 NECK LN UNIT 320
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-3437
Practice Address - Country:US
Practice Address - Phone:347-789-0263
Practice Address - Fax:347-789-0263
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI030915001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice