MEDICARE: MARTIN HOWARD BORCHARDT 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	D11739	MN
2	122300000X	Dentist	4567015	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316903800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN HOWARD BORCHARDT DDS

Provider Business Mailing Address
First Line	:	6600 FRANCE AVE S STE 415
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-1817
Country	:	US
Telephone Number	:	952-224-9771
Fax Number	:	952-224-9790

Provider Business Practice Location Address
First Line	:	8711 E POINT DOUGLAS RD S
Second Line	:
City	:	COTTAGE GROVE
State	:	MN
Zip	:	55016-5000
Country	:	US
Telephone Number	:	651-379-9892
Fax Number	:	651-379-9893

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

Provider Enumeration Date	:	04/24/2006
Last Update Date	:	06/19/2008

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