Provider Demographics
NPI:1043401268
Name:BORRERO, DANIEL A (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:BORRERO
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 1:3252 CERRILLOS RD STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-3001
Mailing Address - Country:US
Mailing Address - Phone:505-954-1128
Mailing Address - Fax:505-954-1132
Practice Address - Street 1:3252 CERRILLOS RD STE A
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-3001
Practice Address - Country:US
Practice Address - Phone:505-954-1128
Practice Address - Fax:505-954-1132
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2007122300000X
NMDD30171223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist