Provider Demographics
NPI:1497971261
Name:BORDIES, ROXANNE BEATRICE (DDS)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:BEATRICE
Last Name:BORDIES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ROXANA
Other - Middle Name:B
Other - Last Name:TAMAYO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13927 95TH AVE
Mailing Address - Street 2:75 W RT. 59 NANUET NY 10977
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-4408
Mailing Address - Country:US
Mailing Address - Phone:718-926-5254
Mailing Address - Fax:
Practice Address - Street 1:75 W ROUTE 59
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2700
Practice Address - Country:US
Practice Address - Phone:845-624-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047047122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01935973Medicaid