MEDICARE: DANIEL A BORRERO D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2007	PR
2	1223P0221X	Pediatric Dentistry	DD3017	NM

General Provider Information

NPI Number	:	1043401268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL A BORRERO D.D.S.

Provider Business Mailing Address
First Line	:	3252 CERRILLOS RD STE A
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-3001
Country	:	US
Telephone Number	:	505-954-1128
Fax Number	:	505-954-1132

Provider Business Practice Location Address
First Line	:	3252 CERRILLOS RD STE A
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-3001
Country	:	US
Telephone Number	:	505-954-1128
Fax Number	:	505-954-1132

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	12/16/2011

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