Healthcare Provider Details

I. General information

NPI: 1427096924
Provider Name (Legal Business Name): WARREN ELLIOT BOARDMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 CHESTNUT ST
RIDGEWOOD NJ
07450-2501
US

IV. Provider business mailing address

75 CHESTNUT ST
RIDGEWOOD NJ
07450-2501
US

V. Phone/Fax

Practice location:
  • Phone: 201-448-8605
  • Fax: 201-445-2040
Mailing address:
  • Phone: 201-445-4808
  • Fax: 201-445-2040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI01753200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI01753200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: