MEDICARE: DR. RUBEN BORRERO-SERRANO 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	841	PR
2	1223G0001X	General Practice Dentistry	DN12272	FL

General Provider Information

NPI Number	:	1285630376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUBEN BORRERO-SERRANO DMD

Provider Business Mailing Address
First Line	:	3833 BROOKMYRA DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32837-5103
Country	:	US
Telephone Number	:	407-856-0208
Fax Number	:

Provider Business Practice Location Address
First Line	:	4250 TOWN CENTER BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32837-6192
Country	:	US
Telephone Number	:	407-856-0208
Fax Number	:	407-856-8113

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	02/25/2013

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