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General NPI Number Information
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NPI Number | 1003919218
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Entity Type | Organization
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Legal Business Name | BORELLO & RIESER DENTAL
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 2745 W CLAY ST STE. E
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2540
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Country | US
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Telephone | 636-946-3566
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Fax | 636-946-8155
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Provider Business Mailing Address
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Address Line | 2745 W CLAY ST STE. E
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2540
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Country | US
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Telephone | 636-946-3566
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Fax | 636-946-8155
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JAMIE M SKINNER
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Credential |
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Telephone | 636-724-2044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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