Provider Demographics
NPI:1144399411
Name:ODINEZ BORTFELD, ELIZABETH NANCY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:NANCY
Last Name:ODINEZ BORTFELD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:NANCY
Other - Last Name:ODINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1 MAYFAIR LANE
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07821
Mailing Address - Country:US
Mailing Address - Phone:973-691-3217
Mailing Address - Fax:
Practice Address - Street 1:2 MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:LONG VALLEY
Practice Address - State:NJ
Practice Address - Zip Code:07853
Practice Address - Country:US
Practice Address - Phone:908-876-3458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI027476001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice