MEDICARE: DR. JOHN BOREL D.D.S.

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	1223G0001X	General Practice Dentistry	031208	CA

General Provider Information

NPI Number	:	1457453904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN BOREL D.D.S.

Provider Business Mailing Address
First Line	:	727 BAYONNE ST
Second Line	:
City	:	EL SEGUNDO
State	:	CA
Zip	:	90245-2104
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3932 WILSHIRE BLVD
Second Line	:	SUITE 100
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3307
Country	:	US
Telephone Number	:	213-386-3336
Fax Number	:

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

Provider Enumeration Date	:	09/04/2006
Last Update Date	:	07/08/2007

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