Provider Demographics
NPI:1891409173
Name:ERIC BORDLEE, DDS, LLC
Entity Type:Organization
Organization Name:ERIC BORDLEE, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:C
Authorized Official - Last Name:BORDLEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-362-4233
Mailing Address - Street 1:6204 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45213-1316
Mailing Address - Country:US
Mailing Address - Phone:513-731-1106
Mailing Address - Fax:
Practice Address - Street 1:6204 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45213-1316
Practice Address - Country:US
Practice Address - Phone:513-731-1106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty