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Deactivated NPI 1891864591 Deactivated / Inactive NPI Male Practitioner

Dr. Charles Richard Cordova , DDS

Dentist - General Practice • Homer, AK

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Charles Cordova has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date November 07, 2006
NPI Deactivation Date April 10, 2025
Total Practice Duration ~19 Years of Practice (2006 – 2025)

Professional Overview & Biography Verified Profile Summary

Dr. Charles Cordova, DDS was a registered Dentist - General Practice practicing in Homer, AK. Throughout an active medical career spanning 19 years, Dr. Cordova provided care at the practice location at 3714 GREAT LAND ST until profile deactivation on 2025-04-10.

Practice Location & Contact Primary Location

Practice Address

3714 Great Land St

Homer, AK 99603

Telephone 9072356106
Fax 9072356107

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Homer, AK

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 4.0 Yrs
Regional Practice Density
7 Specialists

Practicing in Homer, AK (346 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License AK AA691

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated April 10, 2025

Record deactivated on April 10, 2025

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 3714 GREAT LAND ST, HOMER, AK 99603 (Tel: 9072356106)

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Updated Business Mailing Address July 08, 2007

Registered at 3714 GREAT LAND ST, HOMER, AK 99603 (Tel: 9072356106)

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Provider Name / Credentials Updated July 08, 2007

Recorded as CHARLES CORDOVA, DDS

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dentist (License #AA691 in AK)

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Initial NPI Registration & Enumeration November 07, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1891864591
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: November 07, 2006
Last Update: July 08, 2007
Deactivation Date: April 10, 2025

Mailing Address

3714 Great Land St

Homer, AK 99603

Phone: 9072356106

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.