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General NPI Number Information
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NPI Number | 1700307097
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Entity Type | Individual
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Provider Name | LENA BORTNEM DDS, MS
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Gender | Female
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Dates
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Enumeration Date | 06/28/2017
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 2200 W INTERSTATE 20 STE 100
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City | ARLINGTON
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State | TX
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Zip | 76017
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Country | US
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Telephone | 817-803-8090
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Fax |
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Provider Business Mailing Address
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Address Line | 2716 ECHO POINT DR
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City | FORT WORTH
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State | TX
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Zip | 76123-1140
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 38317
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DDS104227
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License Number State | CA
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