Healthcare Provider Details

I. General information

NPI: 1952393167
Provider Name (Legal Business Name): THOMAS W BORDERS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5803 YOUREE DR SUITE C
SHREVEPORT LA
71105-4243
US

IV. Provider business mailing address

5803 YOUREE DR SUITE C
SHREVEPORT LA
71105-4243
US

V. Phone/Fax

Practice location:
  • Phone: 318-868-0535
  • Fax: 318-868-0572
Mailing address:
  • Phone: 318-868-0535
  • Fax: 318-868-0572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2778
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: