MEDICARE: DR. SHELDON MARK BORUCHOW 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	122300000X	Dentist	DS019398L	PA
2	1223G0001X	General Practice Dentistry	DS019398L	PA

General Provider Information

NPI Number	:	1194848481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHELDON MARK BORUCHOW DDS

Provider Business Mailing Address
First Line	:	2901 EAGLEVILLE RD
Second Line	:
City	:	AUDUBON
State	:	PA
Zip	:	19403-1828
Country	:	US
Telephone Number	:	610-666-6045
Fax Number	:	610-666-8585

Provider Business Practice Location Address
First Line	:	2901 EAGLEVILLE RD
Second Line	:
City	:	AUDUBON
State	:	PA
Zip	:	19403-1828
Country	:	US
Telephone Number	:	610-666-6045
Fax Number	:	610-666-8585

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	09/11/2025

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