Healthcare Provider Details

I. General information

NPI: 1083306591
Provider Name (Legal Business Name): LARIE ANN BORGERDING RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W 12TH AVE FL HALL2
COLUMBUS OH
43210-1267
US

IV. Provider business mailing address

14 GREENHILLS DR
MINSTER OH
45865-8705
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-4927
  • Fax: 614-292-3565
Mailing address:
  • Phone: 419-733-9666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH-007854
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: