Provider Demographics
NPI:1043363625
Name:BORG, N MICHELLE (DDS)
Entity Type:Individual
Prefix:MRS
First Name:N
Middle Name:MICHELLE
Last Name:BORG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 RALEY BLVD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-8351
Mailing Address - Country:US
Mailing Address - Phone:530-342-0104
Mailing Address - Fax:530-342-8009
Practice Address - Street 1:111 RALEY BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-8351
Practice Address - Country:US
Practice Address - Phone:530-342-0104
Practice Address - Fax:530-342-8009
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2012-03-23
Deactivation Date:2007-03-12
Deactivation Code:
Reactivation Date:2012-03-23
Provider Licenses
StateLicense IDTaxonomies
CA353291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice