Provider Demographics
NPI:1083306591
Name:BORGERDING, LARIE ANN (RDH)
Entity Type:Individual
Prefix:
First Name:LARIE
Middle Name:ANN
Last Name:BORGERDING
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 GREENHILLS DR
Mailing Address - Street 2:
Mailing Address - City:MINSTER
Mailing Address - State:OH
Mailing Address - Zip Code:45865-8705
Mailing Address - Country:US
Mailing Address - Phone:419-733-9666
Mailing Address - Fax:
Practice Address - Street 1:305 W 12TH AVE FL HALL2
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1267
Practice Address - Country:US
Practice Address - Phone:614-292-4927
Practice Address - Fax:614-292-3565
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDH-007854124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist