Healthcare Provider Details

I. General information

NPI: 1306202916
Provider Name (Legal Business Name): MIGUEL FERNANDO BORDA, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 01/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 FOREST HILL BLVD SUITE 205
WEST PALM BEACH FL
33406-8902
US

IV. Provider business mailing address

1825 FOREST HILL BLVD SUITE 205
WEST PALM BEACH FL
33406-8902
US

V. Phone/Fax

Practice location:
  • Phone: 561-733-9099
  • Fax:
Mailing address:
  • Phone: 561-733-9099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN19392
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN19160
License Number StateFL

VIII. Authorized Official

Name: MR. GILBERTO HERRERA
Title or Position: MANAGER
Credential:
Phone: 561-312-9372