MEDICARE: MR. GARY CURTIS BORGE DDS

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	1223G0001X	General Practice Dentistry	38397	CA

General Provider Information

NPI Number	:	1144307380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY CURTIS BORGE DDS

Provider Business Mailing Address
First Line	:	2550 W EL CAMINO AVE
Second Line	:	SUITE 9
City	:	SACRAMENTO
State	:	CA
Zip	:	95833-3900
Country	:	US
Telephone Number	:	916-649-0249
Fax Number	:	916-649-0258

Provider Business Practice Location Address
First Line	:	2550 W EL CAMINO AVE
Second Line	:	SUITE 9
City	:	SACRAMENTO
State	:	CA
Zip	:	95833-3900
Country	:	US
Telephone Number	:	916-649-0249
Fax Number	:	916-649-0258

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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