MEDICARE: DR. THOMAS CHRISTOPHER BORK DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	043585	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7949	OTHER		B/S-CHP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023199957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS CHRISTOPHER BORK DDS

Provider Business Mailing Address
First Line	:	2061 RIDGE RD W
Second Line	:	SUITE 1
City	:	ROCHESTER
State	:	NY
Zip	:	14626-2718
Country	:	US
Telephone Number	:	585-227-4570
Fax Number	:	585-227-5410

Provider Business Practice Location Address
First Line	:	2061 RIDGE RD W
Second Line	:	SUITE 1
City	:	ROCHESTER
State	:	NY
Zip	:	14626-2718
Country	:	US
Telephone Number	:	585-227-4570
Fax Number	:	585-227-5410

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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