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General NPI Number Information
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NPI Number | 1780948794
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Entity Type | Individual
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Provider Name | TYLER DALE BORG D.D.S. , M.S.
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Gender | Male
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Dates
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Enumeration Date | 06/25/2012
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Last Update Date | 04/20/2017
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Provider Practice Location Address
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Address Line | 11178 HURON ST STE 100
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City | NORTHGLENN
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State | CO
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Zip | 80234-3115
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Country | US
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Telephone | 303-457-9617
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Fax |
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Provider Business Mailing Address
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Address Line | 11178 HURON ST STE 100
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City | NORTHGLENN
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State | CO
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Zip | 80234-3115
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Country | US
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Telephone | 303-457-9617
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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 | 202449
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License Number State | CO
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