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General NPI Number Information
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NPI Number | 1013166289
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Entity Type | Individual
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Provider Name | DEREK STEVEN BORGWARDT D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/12/2008
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Last Update Date | 09/12/2008
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Provider Practice Location Address
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Address Line | 801 NEWTON ROAD UNIVERSITY OF IOWA
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City | IOWA CITY
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State | IA
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Zip | 52242-1001
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Country | US
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Telephone | 319-335-7238
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Fax | 319-335-7239
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Provider Business Mailing Address
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Address Line | 25 LINCOLN AVE APT 12
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City | IOWA CITY
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State | IA
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Zip | 52246-2213
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Country | US
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Telephone | 563-357-2286
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 08578
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License Number State | IA
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