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General NPI Number Information
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NPI Number | 1710672373
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Entity Type | Individual
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Provider Name | ERIC ARDEEN BORTNEM DMD, MS
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Gender | Male
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Dates
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Enumeration Date | 04/10/2023
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Last Update Date | 04/15/2026
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Provider Practice Location Address
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Address Line | 809 SW ALSBURY BLVD # 100
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City | BURLESON
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State | TX
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Zip | 76028-9200
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Country | US
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Telephone | 817-426-1406
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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 | 605-999-1619
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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 | 38697
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License Number State | TX
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