MEDICARE: MICA BORGUETA DMD

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	26325	FL

General Provider Information

NPI Number	:	1215563556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICA BORGUETA DMD

Provider Business Mailing Address
First Line	:	8013 THOROUGHBRED LOOP
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33773-1672
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5265 PARK BLVD N STE 100
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781-3451
Country	:	US
Telephone Number	:	727-564-9819
Fax Number	:

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

Provider Enumeration Date	:	03/18/2020
Last Update Date	:	07/11/2023

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