Provider Demographics
NPI:1003010018
Name:BORGEN, KARI
Entity Type:Individual
Prefix:DR
First Name:KARI
Middle Name:
Last Name:BORGEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 NW COUCH ST
Mailing Address - Street 2:#820
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-4199
Mailing Address - Country:US
Mailing Address - Phone:503-635-9371
Mailing Address - Fax:503-635-1559
Practice Address - Street 1:440 A AVE
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3038
Practice Address - Country:US
Practice Address - Phone:503-635-9371
Practice Address - Fax:503-635-1559
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD87041223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics