Provider Demographics
NPI:1649316522
Name:BODONI, ELENA ISABELA (DDS)
Entity type:Individual
Prefix:MRS
First Name:ELENA
Middle Name:ISABELA
Last Name:BODONI
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 1:6900 E BELLEVIEW AVE
Mailing Address - Street 2:#203
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80111
Mailing Address - Country:US
Mailing Address - Phone:303-781-2107
Mailing Address - Fax:303-781-1830
Practice Address - Street 1:6900 E BELLEVIEW AVE
Practice Address - Street 2:#203
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80111
Practice Address - Country:US
Practice Address - Phone:303-781-2107
Practice Address - Fax:303-781-1830
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8715122300000X
NY047818122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist