Provider Demographics
NPI:1427050541
Name:BORNFELD, MARK HOWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:HOWARD
Last Name:BORNFELD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1865 OCEAN AVE
Mailing Address - Street 2:FL 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6288
Mailing Address - Country:US
Mailing Address - Phone:718-258-5001
Mailing Address - Fax:
Practice Address - Street 1:1865 OCEAN AVE
Practice Address - Street 2:FL 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6288
Practice Address - Country:US
Practice Address - Phone:718-258-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0323651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice