Healthcare Provider Details

I. General information

NPI: 1073135711
Provider Name (Legal Business Name): DAVID BOROTA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2020
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 SW RAMSEY AVE
GRANTS PASS OR
97527-5816
US

IV. Provider business mailing address

1722 13TH AVE SW
OLYMPIA WA
98502-5716
US

V. Phone/Fax

Practice location:
  • Phone: 541-471-9392
  • Fax:
Mailing address:
  • Phone: 360-705-1696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD12152
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: