MEDICARE: ERIC CRAMER BORDLEE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	30.027026	OH

General Provider Information

NPI Number	:	1568924827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC CRAMER BORDLEE DDS

Provider Business Mailing Address
First Line	:	6204 RIDGE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45213-1316
Country	:	US
Telephone Number	:	513-731-1106
Fax Number	:

Provider Business Practice Location Address
First Line	:	6204 RIDGE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45213-1316
Country	:	US
Telephone Number	:	513-731-1106
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2019
Last Update Date	:	01/30/2023

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