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General NPI Number Information
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NPI Number | 1306202916
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Entity Type | Organization
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Legal Business Name | MIGUEL FERNANDO BORDA, P.A.
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 01/12/2016
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Provider Practice Location Address
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Address Line | 1825 FOREST HILL BLVD SUITE 205
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City | WEST PALM BEACH
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State | FL
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Zip | 33406-8902
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Country | US
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Telephone | 561-733-9099
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Fax |
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Provider Business Mailing Address
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Address Line | 1825 FOREST HILL BLVD SUITE 205
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City | WEST PALM BEACH
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State | FL
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Zip | 33406-8902
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Country | US
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Telephone | 561-733-9099
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. GILBERTO HERRERA
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Credential |
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Telephone | 561-312-9372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN19160
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN19392
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License Number State | FL
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