Provider Demographics
NPI:1073679965
Name:BORDEN, CHRISTOPHER DALE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DALE
Last Name:BORDEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:1201 21ST STREET
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-0458
Mailing Address - Country:US
Mailing Address - Phone:205-486-3113
Mailing Address - Fax:205-486-2641
Practice Address - Street 1:1201 21ST ST
Practice Address - Street 2:
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565-1812
Practice Address - Country:US
Practice Address - Phone:205-486-3113
Practice Address - Fax:205-486-2641
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL54641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice