Individual
ELIZABETH BAKER BORTELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
2924 BROOK RD, CREDENTIALING DEPT, RICHMOND, VA 23220-1215
(804) 321-7474
(804) 228-5970
Mailing address
2924 BROOK RD, CREDENTIALING DEPT, RICHMOND, VA 23220-1215
(804) 321-7474
(804) 228-5970
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
0401410308
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0401410308
PROFESSIONAL LICENSE
VA
Enumeration date
10/12/2006
Last updated
09/20/2010
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