Provider Demographics
NPI:1023199957
Name:BORK, THOMAS CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CHRISTOPHER
Last Name:BORK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2061 RIDGE RD W
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-2718
Mailing Address - Country:US
Mailing Address - Phone:585-227-4570
Mailing Address - Fax:585-227-5410
Practice Address - Street 1:2061 RIDGE RD W
Practice Address - Street 2:SUITE 1
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-2718
Practice Address - Country:US
Practice Address - Phone:585-227-4570
Practice Address - Fax:585-227-5410
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0435851223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
7949OtherB/S-CHP
NY01294339Medicaid