Provider Demographics
NPI:1316244387
Name:OLDENDORP, ELIZABETH HELWIG (DMD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:HELWIG
Last Name:OLDENDORP
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 MILLBURN AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1945
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:90 MILLBURN AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1945
Practice Address - Country:US
Practice Address - Phone:973-762-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-27
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024756001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry