Provider Demographics
NPI:1871669408
Name:ELMENDORF, ROSHANAK (DDS)
Entity Type:Individual
Prefix:
First Name:ROSHANAK
Middle Name:
Last Name:ELMENDORF
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:142 MAIN ST
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07403
Mailing Address - Country:US
Mailing Address - Phone:973-283-2900
Mailing Address - Fax:973-283-1154
Practice Address - Street 1:142 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:NJ
Practice Address - Zip Code:07403
Practice Address - Country:US
Practice Address - Phone:973-283-2900
Practice Address - Fax:973-283-1154
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD18731122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist