Healthcare Provider Details

I. General information

NPI: 1225605413
Provider Name (Legal Business Name): JONATHAN BORG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 N HIGHWAY 67
CEDAR HILL TX
75104-2139
US

IV. Provider business mailing address

618 N HIGHWAY 67
CEDAR HILL TX
75104-2139
US

V. Phone/Fax

Practice location:
  • Phone: 972-291-0297
  • Fax:
Mailing address:
  • Phone: 972-291-0297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number42735
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: