Provider Demographics
NPI:1093568354
Name:ELCIK AND BORDIERI, LLC
Entity Type:Organization
Organization Name:ELCIK AND BORDIERI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:CARLETON
Authorized Official - Last Name:BORDIERI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:619-550-6379
Mailing Address - Street 1:850 SW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-2759
Mailing Address - Country:US
Mailing Address - Phone:541-526-0019
Mailing Address - Fax:
Practice Address - Street 1:850 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2759
Practice Address - Country:US
Practice Address - Phone:541-526-0019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental