Provider Demographics
NPI:1811363377
Name:EMILY BORDNER, DDS, LLC
Entity Type:Organization
Organization Name:EMILY BORDNER, DDS, LLC
Other - Org Name:FIRSTSMILES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:SAYURI
Authorized Official - Last Name:BORDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-988-2636
Mailing Address - Street 1:2752 WOODLAWN DR
Mailing Address - Street 2:STE 5-207
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1802
Mailing Address - Country:US
Mailing Address - Phone:808-988-2636
Mailing Address - Fax:
Practice Address - Street 1:2752 WOODLAWN DR
Practice Address - Street 2:STE 5-207
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-1802
Practice Address - Country:US
Practice Address - Phone:808-988-2636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-20071223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI56971701Medicaid