Elise Borja, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1002215-15 Issued in WI

Practice address

3712 Kadow St
Manitowoc, WI 54220-5450

Phone

(920) 684-8033

NPI assigned

Apr 11, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lake Breeze Dental, LLC

  • Dental Clinic/Center
  • Manitowoc, WI
  • NPI 1811871197
  NPD
• Family Dental Center, SC

  • Dentist
  • Manitowoc, WI
  • NPI 1639246127
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765756800000",
    "number": "1508329921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3712 KADOW ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542205450",
            "telephone_number": "920-684-8033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3712 KADOW ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542205450",
            "telephone_number": "920-684-8033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORJA",
        "first_name": "ELISE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-11",
        "last_updated": "2025-12-15",
        "certification_date": "2025-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "1002215-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Bonin, MSW, LCSW
• Abram Richard Bonneville, PA-S
• Brian L Boomgarden, MS CADC
• Justine Boonperm
• Katherine Borchardt, RN
• Nathan Borlee
• Autumn Bosch
• Sarah Jane Bouc, NP-C
• Stacy Bouplon, LPN
• Maren Bourelle

• All providers in Manitowoc, WI
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.